FG - Management of Communicable Diseases - 22122018-1-1

THE UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND

CHILDREN
DIRECTORATE OF HUMAN RESOURCE DEVELOPMENT
FACILITATORS GUIDE FOR ORDINARY DIPLOMA

IN NURSING AND MIDWIFERY
NTA LEVEL 5
NMT 05211: MANAGEMENT OF COMMUNICABLE DISEASES

© Ministry of Health, Community Development, Gender, Elderly and Children, Department of Human Resources
Development Nursing Training Section 2018, Dodoma, Tanzania
NMT 05211: Management of Communicable Diseases ii

Table of Contents
Acronyms................................................................................................................................................. iv
preamble................................................................................................................................................... v
acknowledgement.................................................................................................................................... vi
1.0. Background................................................................................................................................. vii
2.0. Rationale..................................................................................................................................... vii
3.0. Goals and objectives of the training manual...............................................................................viii
3.1. Overall goal for training manual..............................................................................................viii
3.2. Objectives for training manual................................................................................................viii
4.0. Introduction.................................................................................................................................viii
4.1. Module overview.................................................................................................................... viii
4.2. Who is the module for?.......................................................................................................... viii
4.3. How is the module organized?...............................................................................................viii
4.4. How should the module be used?............................................................................................ix
Session one: basic concepts of research...............................................................................................10
session two: writing an introduction of a research proposal...................................................................17
session three: formulating research questions and objectives...............................................................25
session four: conducting a literature review............................................................................................32
session five: research designs................................................................................................................39
session six: sampling techniques and sample size................................................................................48
session seven: data collection methods and tools..................................................................................58
session eight: developing data analysis plan..........................................................................................65
session nine: developing research work plan and budget......................................................................73
session ten: research ethics................................................................................................................... 82
session eleven: developing and using data colletion tools.....................................................................89
session twelve: analysis of collected research data...............................................................................97
session thirteen: writing a research report............................................................................................102
NMT 05211: Management of Communicable Diseases iii

Acronyms
AGYW Adolescents Girl and Young Women
AIDS Acquired Immune Deficiency Syndrome
AIHA American International Health Alliance
ARV Antiretroviral
VMMC Voluntary Medical Male Circumcision
WHO World Health Organization
NMT 05211: Management of Communicable Diseases iv

Preamble
The Ministry of Health Community Development Gender Elderly and Children among other roles
ensures that Tanzanians receive quality health care and service. This can be achieved through
production of competent nurses and midwives amongst other health cadres. The training of competent
nurses and midwives can be achieved through various teaching and learning materials; one of them
being facilitators guides and students manual .
The challenges of today in nursing profession include among others, the preparation of the competent
nurses and midwives to meet the current and future complex clients needs. Therefore, the provision of
quality training to learners in nursing and midwifery is crucial in achieving the intended exit outcomes.
Therefore monitoring of the learners acquisition of practical competences is the cornerstone for judging
effectiveness of the programme. A logbook serves as a key instrument for monitoring the ability of the
learner towards deliberation of the expected quality of care to all clients in all areas of health care
services. The current logbook has taken into consideration the competencies stipulated in the revised
curriculum in order to meet the current societal, institutional and professional needs.
This Practical Experience Logbook is deemed to be an important tool to verify learners acquisition of
the necessary competences needed for the provision of quality health care services. Furthermore, it is
anticipated to also be used by other stakeholders of health care delivery industry in verifying the ability
of the graduate to deliver respected health care.
Dr. Otilia F. Gowelle

Director for Human Resource Development
Ministry of Health, Community Development, Gender, Elderly and Children
NMT 05211: Management of Communicable Diseases v

Acknowledgement
Ministry of Health, Community Development, Gender, Elderly and Children through the Directorate of
Human Resource Development, Nursing training section has reviewed Facilitators guide for Nursing
and Midwifery training program. The review was informed by revised curriculum of the same. The
successfully completion of this facilitators guide has been made possible by the commitment of the
technical team through a series of writers workshops. Understanding the crucial role of the team, the
Ministry would like to express sincere appreciation to all those who involved in the completion of this
task.
Special gratitude goes to coordinators of Nursing and Midwifery training, technical expert from NACTE
and other facilitators who tirelessly supported the development of this guide whose names are listed
with appreciation:-
SN FULL NAME INSTITUON/ORGANIZATION

1. Nassania Shango CDNT -MOHCDGEC-Dodoma
2. Professor Eliezer Tumbwene Lecturer -Aga Khan University
3. Ramadhani Samainda NACTE-Dodoma
4. Dr. Patrick Mwidunda Program Manager-Amref Health Africa
5. Lupyana Kahemela Program Officer-Amref Health Africa
6. Joseph Pilot Program Officer- Amref Hhealth Africa
7. Mary Kipaya Principal- Kahama School of Nursing
8. Paul Magesa Ag. Principal Newala School of Nursing
9. Dominic Daudi Tutor Newala School of Nursing
10. Dr. Beatrice Mwilike Lecturer-MUHAS
11. Lilian Wilfred Tutor KCMC School of Nursing
12. Upendo Mamchony Tutor KCMC School of Nursing
13. Tito William Nurse Officer Muhimbili National Hospital
14. Sixtus Ruyumbu Nurse Officer- Mbeya Refferal
Dr Lenatus Kalolo Medical Specialist-Mbeya Regional Refferal
15.
Hospital
16. Emmanuel Mwakapasa Principal Mbeya -OTM
17. Salma Karim Tutor- Mirembe School of Nursing
18. Athanas Paul Principal- Mirembe School of Nursing
19. Dr. Mwandu Kini Jiyenze Tutor -CEDHA
20. Joseph Mayunga Tutor- Kisare College of Health Sciences
21. Elizabeth Kijugu Principal-Kairuki School of Nursing
22. Charles Magwaza Principal Njombe School of Nursing
23. Meshack Makojijo Tutor Bugando School of Nursing
24. Stella Kiwale Tutor- PHN Morogoro
25. Evance Anderson Tutor Geita School of Nursing
26. Juliana Malingumu Tutor Mchukwi School of Nursing
27. Rehema Mtonga Tutor -
28. Masunga Iseselo Assistant Lecturer -MUHAS
29. Mbaruku Luga Driver-Mirembe School of Nursing
Lastly would like to thank the collaboration and financial support from Amref Health Africa who made
this task successfully completed.
Ndementria Arthur Vermand
NMT 05211: Management of Communicable Diseases

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Assistant Director Nursing Training Section, Ministry of Health, Community Development,
Gender, Elderly and Children
1.0. Background
In 2015 the Ministry of Health, Community Development, Gender, Elderly and Children through the
Directorate of Human Resource Development, Nursing training section started the process of reviewing
the nursing curricula NTA level 4-6. The process completed in the year 2017 and its implementation
started in the same year. The rationale for review was to comply with the National Council for Technical
award (NACTE) Qualification framework which offers a climbing ladder for higher skills opportunity.
Amongst other rationale was to meet the demand of the current health care service delivery. The
demand is also aligned with human resource for health strategic plan and human resource for health
production plan which aims at increasing number of qualified human resource for health.
The process of producing qualified human resource for health especially nurses and midwives requires
the plentiful investment of resources in teaching at the classroom and practical setting and the
achievement of clinical competence is acquired in step wise starting from classroom teaching to skills
laboratory teaching. In addition, WHO advocates for skilled and motivated health workers in producing
good health services and increase performance of health systems (WHO World Health Report, 2006).
Moreover, Primary Health Care Development Program (PHCDP) (2007-15) needs the nation to
strengthen and expand health services at all levels. This can only be achieved when the Nation has
adequate, appropriately trained and competent work force who can be deployed in the health facilities
to facilitate the provisions of quality health care services.
In line with the revised curricula, the MOHCDGEC in collaboration with developing partners and team of
technical staff developed quality standardized training materials to support the implementation of
curricula. These training materials address the foreseen discrepancies in the implementation of the
curricula by training institutions.
This facilitators guide has been developed through a series of writers workshop (WW) approach. The
goals of Writers Workshop were to develop high-quality, standardized teaching materials and to build
the capacity of tutors to develop these materials. The new training package for NTA Level 4-6 includes
a Facilitator Guide and Student Manual. There are 33 modules with approximately 520 content
sessions
2.0. Rationale
The vision and mission of the National Health Policy in Tanzania focuses on establishing a health
system that is responsive to the needs of the people, and leads to improved health status for all.
Skilled and motivated health workers are crucially important for producing good health through
increasing the performance of health systems (WHO, 2006). With limited resources (human and non-
human resources), the MOHSW supported tutors by developing standardized training materials to
accompany the implementation of the developed CBET curricula. These training manuals address the
foreseen discrepancies in the implementation of the new curricula.
Therefore, this training manual for Certificate and Diploma program in Nursing (NTA Levels 4-6) aims at
providing a room for Nurses to continue achieving skills which will enable them to perform competently.
These manuals will establish conducive and sustainable training environment that will allow students
and graduates to perform efficiently at their relevant levels. Moreover, this will enable them to aspire for
attainment of higher knowledge, skills and attitudes in promoting excellence in nursing practice.

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3.0. Goals and Objectives of the Training Manual
3.1. Overall Goal for Training Manual
The overall goal of these training manuals is to provide high quality, standardized and competence-
based training materials for Diploma in nursing (NTA level 4 to 6) program.
3.2. Objectives for Training Manual

To provide high quality, standardized and competence-based training materials.
To provide a guide for tutors to deliver high quality training materials.
To enable students to learn more effectively.
4.0. Introduction
4.1. Module Overview
This module content has been prepared as a guide for tutors of NTA Level 6 for training students. The
session contents are based on the sub-enabling outcomes of the curriculum of NTA Level 6 Ordinary
diploma in Nursing and Midwifery.
The module sub-enabling outcome as follows:
3.3.2. Describe basic concepts of action research in nursing and midwifery practice
3.3.2. Develop research proposal by applying knowledge of research
3.3.3. Collect data for a research study by using knowledge of research
3.3.4 .Process research data by using statistical package
3.3.5. Produce research report by using knowledge of research
4.2. Who is the Module For?

This module is intended for use primarily by tutors of NTA Level 4 certificate and diploma in nursing
schools.
The module sessions give guidance on the time and activities of the session and provide information
on how to teach the session to students. The sessions include different activities which focus on
increasing students knowledge, skills and attitudes.
4.3. How is the Module Organized?

The module is divided into 13 sessions; each session is divided into sections. The following are the
sections of each session:
 Session Title: The name of the session.
 Learning Tasks Statements which indicate what the student is expected to learn at the end of the
session.
 Session Content All the session contents are divided into steps. Each step has a heading and an
estimated time to teach that step. Also, this section includes instructions for the tutor and activities
with their instructions to be done during teaching of the contents.
 Key Points Each session has a step which concludes the session contents near the end of a
session. This step summarizes the main points and ideas from the session.
 Evaluation The last section of the session consists of short questions based on the learning
objectives to check the understanding of students.
 Handouts are additional information which can be used in the classroom while teaching or later for
students further learning. Handouts are used to provide extra information related to the session
topic that cannot fit into the session time. Handouts can be used by the participants to study
material on their own and to reference after the session. Sometimes, a handout will have questions
or an exercise for the participants. The answers to the questions are in the Facilitator Guide
Handout, and not in the Student Manual Handout.

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4.4. How Should the Module be Used?
Students are expected to use the module in the classroom and clinical settings and during self-study.
The contents of the modules are the basis for learning Fundamentals of Research .Students are
therefore advised to learn each session and the relevant handouts and worksheets during class hours,
clinical hours and self-study time. Tutors are there to provide guidance and to respond to all difficulty
encountered by students.

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SESSION 1: CONCEPTS OF COMMONICABLE DISEASES IN
NURSING PRACTICES
Total Session Time: 60 minutes
Pre-requisite: none
Learning Tasks
At the end of this session a learner is expected to be able to:
Define communicable disease, contagious disease, host, susceptible host, reservoir, incubation
period and carrier
Outline routes of communicable disease transmission
Explain main methods of communicable disease prevention and control
Resources Needed
 Flip charts, marker pens, and masking tape
 Black/white board and chalk/whiteboard markers
 LCD Projector and computer
 Note Book and Pen
Session Overview
Step Time (min) Activity/ Content
Method
1 05 Presentation Session Title and Learning Tasks
2 15 Buzzing /Presentation Concepts of Communicable Diseases
3 15 Brainstorming/Presentation Routes of Communicable Disease

Transmission
4 15 Presentation Main Methods of Communicable Disease
Prevention and Control

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7 05
Presentation Evaluation
8 05
Presentation Key points
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning tasks (5 minutes)
READ or ASK participants to read the learning tasks
ASK participants if they have any questions before continuing
STEP 2: Concepts of Communicable Diseases (15 Minutes)
Activity: Buzzing (5 minutes)

 ASK a pair of students to define the term communicable disease.
 ALLOW 2 to 3 students to provide responses and let others provide additional responses
 WRITE their responses on the board/flipchart
 CLARIFY and summarize by using the content below
 Communicable disease (transmissible disease): a disease whose causal agent can be transmitted
from successive hosts to healthy subjects, from one individual to another; it also an illness due to a
specific infectious agent or its toxic products that arises through transmission of such agent or
products from an infected person, animal, or reservoir to a susceptible host, either directly or
indirectly through an intermediate plant or animal host, vector, or the inanimate environment
 Contagious disease: a disease transmitted by direct or indirect contact with a host that is the
source of the pathogenic agent
 Host: a person or other living animal, including birds and arthropods, that affords subsistence or
lodgement to an infectious agent under natural conditions
 Susceptible host: host that can develop a disease or condition when infected or affected by causal
agent
 Reservoir: any person, animal, arthropod, plant, soil, or substance, or combination of these in
which an infectious agent normally lives and multiplies, on which it depends primarily for survival,
and where it reproduces itself in such a manner that it can be transmitted to a susceptible host

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 Carrier: a person or animal harbouring a specific infectious agent in the absence of discernible
clinical disease and which serves as a potential source of infection or is a person who can transmit
the infective agent, but is not manifesting the disease
 Incubation period: the time interval between invasion by an infectious agent and appearance of the
first sign or symptom of the disease in question
STEP 3: Routes of Transmission of Communicable Diseases (15 Minutes)
Activity: Brainstorming (5 minutes)

 ASK each student to list two routes of transmission of communicable diseases”.
 Transmission of infection refers to a process, or mechanisms by which an infectious agent or an

infectious disease are spread from a source or reservoir to another person or across communities and
countries
 An organism may be transmitted from its reservoir by various means or routes of transmission
 Organisms or infectious agents can be transmitted by two broad routes of transmission
o Direct transmission routes involves proximity between susceptible host and an infected person or
a carrier, such as touching, kissing, or sexual intercourse
o Indirect transmission routes involves personal contact with an inanimate object, such as touching
contaminated instruments
 Vehicle transmission-involves the transfer of microorganisms by way of vehicle, or
contaminated items that transmit pathogens (food carry salmonella, blood carry hepatitis
and HIV; drugs can carry bacteria from contaminated infusion supplies.)
 Droplet transmission: occurs when mucous membranes of the nose, mouth, or conjunctiva
are exposed to secretions of an infected person who is coughing, sneezing, or talking.
 Airborne: occurs when fine particles are suspended in the air for a long time or when dust
particles contain pathogens
 Vector borne transmission: such as mosquitoes, ticks, and lice, are non-human carriers
that transmit organisms from one host to another.
 The common transmission routes are shown in figure 1.1

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Figure 1.1. Agent, transmission, host, and environment (Source: (Webber, 2005)
STEP 4: Main methods of communicable disease prevention and control (15 Minutes)
 Disease control is about keeping diseases at a minimum level so that it is no longer poses a health
problem or reducing the number and severity of the cases to a tolerable level
 Elimination is a reduction of case transmission to a predetermined very low level; e.g., elimination of
tuberculosis as a public health problem was defined by the WHO (1991) as reduction of prevalence to
a level below one case per million population
 Control and prevention of communicable diseases can be achieved through the following main
methods:
o Conducting surveillance: routine collecting, analyzing and using information diseases for
action
o Conducting epidemiological studies: studying frequency and pattern of diseases/outcomes,
testing preventive and therapeutic intervention
o Conducting Laboratory diagnosis diseases for confirming cases
o Immunization: giving vaccines to individuals
o Treatment of diseases/cases: treating people with the diseases
o Giving chemophylaxis: giving antibiotics other medicines to prevent infections
o Providing Education: imparting knowledge, attitudes and skills that help people to prevent and
control diseases
o Improving environmental cleanness, sanitation and water

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o Controlling vectors
o Enacting Legislation: legislation facilitate enforcement of disease control if people are now
willing to participate
STEP 7: Key Points (05 minutes)

 Communicable diseases affect many people in Tanzania and other countries
 Communicable diseases can be transmitted from one person to another various specific routes of
transmissions
 Communicable diseases can be prevented and controlled using various methods
STEP 5: Session Evaluation (5 minutes)

 Ask learners to answer the following questions:
1. What is a communicable disease?
2. What are the two main routes of transmission for communicable diseases?
3. What are main methods of preventing and controlling communicable diseases?
References
Heymann, D. L. (2004). Control of communicable diseases manual (18th Edition).New York: American
Public Health Association
Porta, M. (Ed.). (2014). A dictionary of epidemiology (six edition). Oxford: Oxford university press.

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Webber, R. (Ed.). (2009). Communicable disease epidemiology and control: A global perspective (2nd
Edition). Wallingford: CABI Publishing
SESSION XXX: PREVENTING DISEASES THROUGH COMMUNITY

PARTICIPATION
Pre-requisite: none

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Learning Tasks
Define prevention
Describe levels of disease prevention in the community
Involve community in disease prevention interventions
Resources Needed
Session Overview

Method
2 15 Presentation/buzzing Definition of Prevention
3 15 Presentation/ Levels of Disease Prevention in the

brainstorming Community
4 15 Presentation Community Involvement in Disease
Prevention Interventions
5 05
6 05
SESSION CONTENTS

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STEP 2: Definition of Prevention (15 Minutes)

 ASK a pair of students to define the term prevention
 Prevention to refers to a set actions or intervention that aimed at stopping (preventing) the occurrence
or minimizing the magnitude and impacts of a disease to an individual or community
 It can also be considered as a process that aim at preventing occurrence or minimizing the magnitude
and impacts of a disease to an individual or community
STEP 3: Levels of Disease Prevention in the Community (15 Minutes)

 ASK each student to mention three levels of prevention of a disease”.
 Prevention can reduce the magnitude or impact of diseases in communities at three levels:
o Primary level prevention: this is concerned with preventing a disease or condition from occurring or
starting; prevention at this level reduces incidence of a disease or condition
o Secondary level prevention: aims to detect the condition at the earliest stage and prevent the
condition from progressing and treating it before complications (screening for pre-cancer cervix or
BP checkup for hypertension); prevention at this level reduces prevalence of disease or condition
o Tertiary prevention: aim at reducing the impacts (effects) of a long-term disease or conditions by
reducing or eliminating or reducing impairment, disability, and handicap done through treatment or
rehabilitation to restore functions.
.

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STEP 4: Community Involvement in Disease Prevention Interventions (15 Minutes)

 ASK each student to list three strategies for engaging community in prevention of diseases”.
 Community involve is an important strategy for preventing communicable diseases and improving
community health.
 The community health improvement process is a strategy for preventing diseases and improving health
of community members.
 Community health process for prevention of diseases is a systematic approach that involves the
following stages:
1) Assessing the need for community health interventions
2) Developing a community health plan for preventing diseases, which analyzing current situation;
identifying and analyzing problems; and assessing and selecting better community health
interventions to health problems;
3) Implementing and monitoring community health interventions;
4) Evaluating community health interventions.
 Community involvement is a process of engaging in dialogue and working with community members
 At all these stages of the community health process, community members can be involved:
o At stage one, community members should be engage to establish the needs for community health
interventions to prevent disease in the community
o At stage two, community members should be engage during the process of developing a
community health intervention plan
o At stage three, community members should be engaged during the process of implementation and
monitoring; community members can participate directly in doing some of activities including
monitoring
o At stage four, community members can participate directly as evaluator the interventions or
provide information/data on whether the interventions are reducing the magnitude of the diseases
or its effects to community members.
 There are five strategies for involving community in preventing diseases and improving health:
o Informing: tell the community members what will be done/need to be done to prevent
diseases
o Consultation: seek information from the community on needs, priorities and strategies for
preventing diseases
o Involvement: plan, implement, monitor and evaluate together with the community members

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o Collaboration: partnering and sharing resources and responsibilities for preventing diseases
with community members
o Empowering: enable or build the capacities the community members to plan, implement,
monitor and evaluation community interventions

 Prevention of diseases is an important strategy for improving community health
 Prevention of diseases can effectively work when community members are involved
 Community members can be involved using five strategies

4. What is disease prevention?
5. Mention three levels of prevention of diseases
6. How can community be involved in disease prevention?
References
Alender, J. A., & Sradley, B. W. (2009). Community health nursing: Promoting and protection the public
health (7 edition).London: Lippincott Williams & Wilkins.
Doyle, E. I., Ward, S. E., & Early, J. (2018). The process of community health education and
promotion(Second edition). Illinois: Waveland Press.
Walley, J., & Wright, J. (2010). Public health: an action guide to improving health ( Ed. 2).Oxford: Oxford
University Press.

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Wright, J., & Walley, J. (1998). Health needs assessment: assessing health needs in developing
countries. BMJ: British Medical Journal, 316(7147), 1819.
SESSION XXX: FORMULATING INTERVENTIONS USING EPIDEMILOGICAL

DATA
Pre-requisite: none
Learning Tasks
Identify epidemiological data
Collect epidemiological data 20
Analyse epidemiological data
Interpret epidemiological data 20
Plan for community health interventions
Resources Needed:
Session Overview

Method
2 10 Presentation/buzzing Identification Epidemiological Data
3 10 Presentation/ Collection of Epidemiological Data

brainstorming
4 35 Presentation/group work Analysing Epidemiological Data
5 10 Presentation Interpreting Epidemiological Data
6 40 Presentation/ group work Planning Community Health Interventions

brainstorming
7 05
8 05
SESSION CONTENTS

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STEP 2: Identification of Epidemiological Data (10 Minutes)

 ASK a pair of students to define the term epidemiological data.
 Data is a collection of items of information

o The singular of data is datum
 Epidemiological data are data or information that describes occurrence and distribution of health-
related states or events in specified populations, and the determinants influencing such states.
 Epidemiological data help:
o to understand health of the community and health problems the community is facing,
o To understand health interventions
o To plan, implement and evaluate health interventions, programmes and project to address
community health problems and needs
 Examples of epidemiological data or information include the following:
o Morbidity data: e.g. prevalence and incident of diseases
o Mortality data: e.g. infant mortality rate, under-five mortality rate, maternal mortality rate
o Knowledge, attitude, behavioural data: relate to knowledge, attitudes, behaviours of community, or
individual
o Health service/intervention data: e.g. immunization coverage, % of people using modern family
planning methods interventions
o Health determinants data: e.g. availability of toilets, clean water, income level of family
o Health resources: number of health facilities, staff, finance of health, vehicle
o Population/client related data: e.g. number of people in a village, age-distribution of a population,
sex-distribution of a population

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 Epidemiological data come from different sources: e.g.
o Documentary sources: such census, health survey, research articles and reports, medical
records and administrative record
o Vital registers: registers the record vital statistics
o People
o Organizations
STEP 3: Collection of Epidemiological Data (10 Minutes)

 ASK each student to mention four common collection methods for epidemiological data”.
 Data collection is a process of gathering a set of data or information in a meaningful and reliable
manner.
 Epidemiological data can be collected using four common data collection methods and tools as follows:
o Observation: this data collection method data uses checklists and rating scales as data
collection tools
o Interviewing: In this method, data are collected using interview guide or schedules
o Reviewing documents: In this methods, data are collected using compilation-sheets
o Administering a questionnaires: In this method, data are collected using questionnaires
STEP 4: Analysing epidemiological data (35 Minutes)
 Data analysis is a process or technique of turning raw research data into meaningful and useful information
or evidence to answer research questions or meet research objectives (Saunders et al., 2012).
 Before data is analysed, they have to be cleaned and processed.
 Data cleaning is a process of excluding incomplete, inconsistent records or irrelevant data or information
collected in a survey or other form of epidemiological study before analysis begins
 Data processing is a process of converting a set of data or information into a form that permits storage,
retrieval, and analysis.
 Data epidemiological data analysis can done by using two broad methods or techniques:
o Quantitative analysis, process of summarizing and turning data into numeric findings using statistical
techniques
o Qualitative analysis, which lead to generation of textual findings in forms of meanings, summary
statements, themes (categories), patterns, relationship, explanations and theories
 Basic quantitative data analysis uses statistical techniques to raw data into meaningful information such as:

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o Numbers
o Percentage
o Mean
o Standard deviation
o Mode
o median
 Epidemiological data can be analyzed manually, using a calculator, common computer programme like
excel, using specialized data analysis software such as Epi-Info, statistical package for social scientist
(SPSS).
Small group work: analysis of epidemiological data (30 minutes)
 DIVIDE students into small manageable groups
 ASK students to calculate the following using data given in the table below
o Percentage
o Mean
o Standard deviation
o Mode
o Median
 ALLOW students to discuss for 20 minutes
 ALLOW 1-2 groups to present and the rest to add points not mentioned
 CLARIFY, DEMONSTRATE, and SUMMARIZE how to analyze the sample data
Table. Number of patients diagnosed with malaria at a district hospital in Tanzania
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Patient 10 9 13 6 15 5 7
Missing summary
STEP 5: Interpreting Epidemiological Data (10 Minutes)

 Once data are turned into meaning information, the information has to be interpreted

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 Interpretation refers to the process of deriving meaning, making inferences and relations pertinent to
the research questions, drawing conclusions and implications of findings within a research and
beyond the research conducted
 The interpretation is done in order to develop an understanding or meaning of information; the which
may show:
o There is an increasing trend compare with previous year, month or day
o Decreasing trend compare with previous year, month or day
o Constant trend no decreasing or increasing compare with previous year, month or day
 Interpretation can be done by:
o Comparing information or data obtained with data from another organization, health facilities or
community
o Comparing obtained data with similar data from other similar dataset or study
o Comparing obtained data with ideal data or information in plan, guideline or policy
STEP 5: Planning for Community Health interventions (40 Minutes)

 Planning is process of developing a plan for delivery or provision of community health interventions
 Community health interventions are a set of interventions or services that seek to improve or promote
health of a community:
 Community health interventions can be classified into:
o Preventive health interventions: interventions that aim at preventing occurrence of diseases (e.g.
immunization, health education)
o Promotive health interventions: health interventions that promote changes in knowledge, attitudes
and behaviours ( e.g health education, environment, sanitation, and water)
o Diagnostic and treatment interventions (e.g. IMCI, correct diagnosis, mass screening for cancer)
 To delivery community health intervention effectively at community level, planning for community health
interventions is important.
 The planning will lead to production of a community health Intervention plan
 A basic community health plan comprises the following parts:
o Situational analysis
 this part seek to identify health needs and problems of the community
o Priorities
 indicate selected health problems and formulated objectives to be achieved
o Interventions and proposed activities:
 this section indicate selected health interventions and activities formulated to facilitate
achievement of set objectives
o Action plan
 this section indicates what activities will be done, when they will implemented, who
will be involved in implementing or coordinating activities and resources needed

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 The steps for developing community health intervention plan are:
o Conduct a situational analysis to identify health needs and community health problems: e,g.
 Health problems: High under-five children mortality rate are due to preventable
communicable and non-communicable diseases, including malaria, pneumonia, diarrhoea
diseases, respiratory diseases, and malnutrition
o Set community health priorities: selecting health problems to be addressed and setting objectives
to be achieved: e.g.
 Health problem: high under-five dearth and morbidities due to preventable diseases
 Objective: To reduced under-five mortality due to preventable diseases from 120/1000 to
110/1000 by next year
o Select or develop or community health interventions and related activities:
 Example of health intervention: IMCI
 Example of activity: conduct training on community IMCI to community health workers or
provide health education on communicable diseases to community members
o Formulate action plan indicating activities, responsible person, timeframe and resources: e.g.
 Activity: provide health education on malaria to community members in village X
 Responsible person: Halima Juma
 Timeframe: next Monday
 Resources needed: hand-out/notice, insecticide treated net, pack of ALU, DVD, TV set,
projector
 Example of simple action plan for community health interventions is shown in Table 2.1
Table 2.1: Basic Community Action Plan

Health problem Intervention Activity Responsible Timeframe Resources
person
High under-five IMCI Provide health Halima Juma Next Hand-out/notice,

dearth and education on Monday insecticide treated
morbidities due communicable net, pack of ALU,
to preventable diseases to DVD, TV set,
diseases community projector
members
Small group work: Developing a community health intervention plan (25 minutes)
 DIVIDE students into small manageable groups

NMT 05211:
 ASK Management
studentsoftoCommunicable Diseaseshealth intervention plan using data given in the table 2.1
prepare community 26
above
26
 ALLOW students to discuss for 15 minutes

 Epidemiological data are important data for planning community health interventions
 Epidemiological data can be collected using various methods and tools
 It is important that collected epidemiological data be analysed before using them to plan for community
health interventions

7. What are epidemiological data?
8. What are the sources of epidemiological data?
9. How can epidemiological data be collected?
10. What parts of basic community health intervention plan?
References

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27
Alender, J. A., & Sradley, B. W. (2009). Community health nursing: Promoting and protection the public
health (7 edition).London: Lippincott Williams & Wilkins.
Doyle, E. I., Ward, S. E., & Early, J. (2018). The process of community health education and
promotion(Second edition). Illinois: Waveland Press.
Green, A (2007).An introduction to health planning for developing health systems(Third edition). London:
Oxford University Press
Porta, M. (Ed.). (2014). A dictionary of epidemiology (six edition). Oxford: Oxford university press.
Walley, J., & Wright, J. (2010). Public health: an action guide to improving health ( Ed. 2).Oxford: Oxford
University Press.
Wright, J., & Walley, J. (1998). Health needs assessment: assessing health needs in developing
countries. BMJ: British Medical Journal, 316(7147), 1819.

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SESSION XXX: PROVIDING CARE TO PATIENT WITH MALARIA
Pre-requisite: none
Learning Tasks
Explain causative agent and vector for malaria
Explain epidemiological distribution for malaria
Describe life cycle for malaria parasites
Outline clinical features of a patient with malaria
Diagnose malaria
Provide care to patient with malaria
Explain prevention and control measures for malaria
Resources Needed:
Session Overview

Method
2 15 Presentation/buzzing Causative Agent and Vector of Malaria
3 15 Presentation/ Epidemiological Distribution for Malaria

brainstorming
4 20 Presentation Life Cycle for Malaria parasites

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5 15 Presentation/ buzzing Clinical Features of a Patient with Malaria
6 15 Presentation/ Diagnostic Techniques for Malaria
brainstorming
7 30 Presentation/ Care to Patient with Malaria
brainstorming
8 10 Presentation/ Prevention and Control Measures for Malaria
brainstorming
9 05
10 05
SESSION CONTENTS
STEP 2: Causative Agent and Vector of Malaria (15 Minutes)

 ASK a pair of students to define the term define the term malaria.
 Malaria is a communicable and parasitic disease caused by the plasmodium parasites

 There are 5 parasite species that cause malaria in humans, and 2 of these species
o Plasmodium falciparum and Plasmodium vivax pose the greatest threat
o Plasmodiu
o Plasmodiu
o oPlasmodiu
 P. falciparum accounted for 99.7% of estimated malaria cases in Africa
 The female anopheles mosquito is an important vector of malaria disease
 Anopheles mosquitoes transmit malaria parasites from one person to another through the mosquito
bites

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STEP 3: Epidemiological Distribution for Malaria (15 Minutes)

 ASK each student to mention three groups of people who mostly affected by malaria
 Malaria is found in the tropics and subtropics of the world and is found in 90 countries
 In 2017, there were an estimated 219 million cases of malaria in 90 countries.
 Malaria deaths were 435 000 in 2017
 Most malaria cases and deaths occur in Sub-Saharan Africa. In 2017, the Sub-Saharan Africa was
home to 92% of malaria cases and 93% of malaria deaths
 More than two thirds (70%) of all malaria deaths occur in children under five years.
 Some population groups are at considerably higher risk of contracting malaria and developing severe
disease than others; these groups include:
o Children under 5 years of age,
o Pregnant women,
o Patients with HIV/AIDS
o non-immune migrants,
o mobile populations and travellers
STEP 4: Life Cycle for Malaria (20 Minutes)

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 The life cycles and development of all plasmodium species takes place in human being and in
mosquito (see figures below).
 There are two cycles in human being which are:
o exo-erythrocytic cycle-human liver stage
o erythrocytes cycle- human blood stage
 There is one cycle in mosquito known as sporogonic cycle- mosquito stage
 During a blood meal, a malaria-infected female Anopheles mosquito inoculates sporozoites into the
human host in which, the sporozoites then infect liver cells and mature into schizonts which later
rupture and release merozoites. In this cycle a dormant stage (hypnozoites) for the species of P. vivax
and P. ovale may occur and can persist in the liver to cause relapses by invading the bloodstream after
weeks, or even years later.)
 After this initial development in the liver, the merozoites are released and infect red blood cells to start
the erythrocytic cycle.
 In the erythrocyte cycle, merozoites in the red blood cells develop into trophozoites.,commonly known
as the ring stage .Trophozoites are commonly seen under the microscope, other forms that can be
see under the microscope are schizonts and gametocyte.
 Later on, the ring stage trophozoites mature into schizonts, which rupture releasing more merozoites in
the blood together with malaria pigments and toxins. The entry of toxins in to the blood stream cause
fever and malaria attack, some of the merozoites will then differentiate into gametocytes in the blood.
The gametocytes in Oithe bloods can now be ingested by female anopheles mosquitoes to start the
sporogonic cycle.
 Mosquito stages (sporogonic cycle) starts when a mosquito bites human being and takes blood meal
that gametocytes are ingested from an infected human being. In the mosquito, gametocytes undergo a
number of growth developments to form zygotes which in turn develop into ookinetes then to oocysts
that later on raptures to release sporozoites ready to be inoculated into a new human host.

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Figure 1. Life Cycle for Malaria (Source: Webber ( 2005))
Figure 2: Life Cycle for Malaria ( source: CDC(2000)).

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STEP 5: Clinical Features of a Patient with Malaria (15 Minutes)

 ASK each student to list four clinical features of a patient with un-complicated malaria”.
 Malaria present in two forms:

o Uncomplicated malaria: uncomplicated malaria is defined as symptomatic malaria without signs of
severity or evidence (clinical or laboratory) of vital organ dysfunction.
o Severe malaria: develop when prompt and effective treatment is not offered to patient with un-
complicated malaria and severe malaria is associated with vital organ dysfunction.
 The following are common clinical features of patients with un-complicated malaria:
o Fever
o Headache
o Joint pains
o Malaise
o Vomiting
o Diarrhoea
o Body ache, body weakness
o Poor appetite
o Pallor, enlarged spleen
 The following are common clinical features of patients with severe malaria:
o Prostration/extreme weakness
o Impaired consciousness
o Change of behaviour
o Convulsions
o Respiratory distress (due to lactic acidosis and/or pulmonary oedema)
o Bleeding tendency
o Jaundice
o Circulatory collapse/shock
o Vomiting everything
o Inability to drink or breast feed
STEP 6: Diagnostic Techniques for Malaria (15 Minutes)

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 ASK each student to list two common tests conduct to diagnose malaria in a patient”.
 The clinical features(signs and symptoms) of malaria are non-specific; therefore diagnostic tests have
to be conducted using two parasitological diagnostic tests:
o Microscopic test: using a thick blood smear (to detect parasites) and a thin smear (to determine
species)
o Malaria Rapid diagnostic test: The test is based on antibody detection of malaria specific antigens
in blood samples. It is simple, rapid, sensitive, highly specific, and increasingly affordable dipstick
or card tests for the diagnosis of malaria has been a major advance in recent years.
 Malaria present clinical features which are common to other diseases such as:
o Bacterial meningitis
o Influenza
o Diabetes mellitus
o hypoglycaemia
STEP 7: Proving care to patients with Malaria (30 Minutes)

 ASK each student to mention types of care given a patient with un-complicated malaria”.
 Patient with malaria receive different care depending on whether they have uncomplicated malaria or
severe malaria
 Before giving care to patients suspected to have malarial, proper assessment of the patients should be
done; pre-care assessment should be done by using the following assessment methods:
o Taking proper history of the patient

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o Conducting physical examination
o Conducting diagnostic tests and investigation
Care of patients with uncomplicated malaria

 Patients with uncomplicated malaria receive two types of care or treatments:
o Non-Pharmacological care: Specific cares are continuing with feeding and fluid intake and making
followed up immediately if the condition worsens or on the fourth day if symptoms persist.
o Pharmacological care: this care involves giving a patient some medications
 Drug of choice for treatment of uncomplicated malaria is Artemether-Lumefantrine (AL),
 AL is a fixed formulation of artemether 20mg and lumefantrine 120mg or dispersible tablets for
paediatric use which has a fixed formulation of artemether 20 mg and lumefantrine 120mg (see table
below for dosage schedule).
 An alternative artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria is

Dihydroartemisinin-Piperaquine (DPQ). 120mg (see table below for dosage schedule).
 Standard tablet, fixed formulation containing 40 mg of Dihydroartemisinin (DHA) and 320 mg
Piperaquine (PPQ). Paediatric formulation contains a fixed combination of 20 mg of Dihydroartemisinin
(DHA) and 160 mg Piperaquine (PPQ). See table below for dosage schedule.
 Patients with high fever (38.50C and above) should be given an antipyretic medicine like paracetamol
or aspirin every 4 to 6 hours (maximum 4 doses in 24 hours) until symptoms resolve, usually after two
days.
 Children below 12 years should not be given aspirin because of the risk of developing Reye's
syndrome.
Table. Dosage regimen for AL (artemether 20mg/lumefantrine 120mg)
Table. Dose schedule for Dihydroartemisinin + Piperaquine

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Care of patients with severe malaria
 Severe malaria should be treated as a medical or nursing emergency
 Management of severe malaria comprises four main principles which are:
o Rapid clinical assessment,
o Taking blood slide (BS) to quantify parasitemia
o Management of emergency conditions,
o Specific antimalarial treatment
o Supportive care
 Two major types of care should be given to patients with severe malaria:
o Non-pharmacological care, which include the following specific care:
 A rapid assessment must be conducted including airway, breathing, circulation, coma,
convulsion, and dehydration status
 Making differential diagnosis(rule out other diseases)
 Management of emergency conditions
 Supportive care
 Giving pre-referral treatment and referred immediately to an appropriate facility for
continued treatment for effective care of severe malaria and supportive care
o Pharmacological care, which include the following specific care:
 Giving Parenteral artesunate(first choice) or giving Injectable artemether ( second
choice)
 Dosage for Parenteral artesunate: 2.4 mg/kg in body weight. IV or IM given on
admission (time = 0 hour), then at 12 hours and 24 hours for a minimum of 3
injections in 24 hours regardless of patients recovery.
 For children weighing less than 20 kg, the dosage is 3 mg/kg/dose (or higher).
Same schedule as indicated above (0, 12, 24 hours) Complete artesunate
injection treatment by giving a complete course (3 days) of artemether-
lumefantrine (AL) or other ACT
 Dosage for Injectable artemether: 3.2mg/kg body weight loading dose IM stat then
1.6mg/kg body weight (time= 0h then at 24 hrs and 48hrs).

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Management of severe malaria complications
 The following severe malaria complications need management as described below:
o Coma (cerebral malaria): maintain airway, nurse on side, and exclude other causes of coma (e.g.
hypoglycemia, bacterial meningitis); avoid giving corticosteroids
o Hyperpyrexia: fanning, paracetamol if patient can swallow
o Convulsions: maintain airways; treat with rectal or IV diazepam 0.15 mg/ kg (maximum 10 mg for
adults.) slow bolus IV injection. In children, diazepam rectal route should be used. Give a dose of
0.51.0 mg/ kg1.
o Hypoglycemia: remains a major problem in the management of severe malaria especially in young
children and pregnant women. Urgent and repeated blood glucose screening; In children: give 5
mls/kg of 10% dextrose OR 2.5 mls/kg of 25% dextrose as bolus; if 50%dextrose solution is
available, it should be diluted to make 25% by adding an equal volume ofwater for injection or
normal saline. In adults: give 125 mls of 10% dextrose OR 50 mls of 25% dextrose as bolus.
o Severe anaemia: transfusion of packed cells if haemoglobin (HB) equal or less than 4 g/dl and/or
signs of heart failure and/or signs of respiratory distress
o Acute pulmonary oedema: Check for restlessness, frothy sputum, basal crepitation, low oxygen
saturation (< 95%). Prop patient up to 45 degree angle; review fluid balance andrun patient on dry
side; give diuretic (IV Furosemide) but avoiding inadequate perfusion of kidneys; set upCentral
Venous pressure (CVP) line, give oxygen. Intubation /ventilation may be necessary
o Acute renal failure: exclude prerenal causes, check fluid balance and urinary sodium. Ifadequately
hydrated (CVP>5cm) try diuretics. Haemodialysis /hemofiltration (or if availableperitoneal dialysis)
should be started early in established renal failure.
STEP 8: Prevention and Control Measures for Malaria (10 Minutes)
 The following are preventive and control measures that can be adopted to reduce morbidities and
mortalities related to malaria:
o Use mosquito bed nets: Insecticide spraying and insecticide-treated bed nets are the main
methods of attacking the vector and controlling malaria.
o Use repellants
o Chemoprophylaxis: use anti-malaria when going to malaria endemic areas
o Use Intermittent preventive treatment: providing a treatment dose of SP help to minimize
morbidities and mortalities to at risk group such as pregnant women and under-five
children
o Use Indoor residual spraying with insecticides (IRS): most effective where mosquitoes rest
indoors on sprayable surfaces, where people are exposed in or near the home, and when
it is applied before the transmission season or period of peak transmission
o eliminate mosquito breeding sites by filling or draining breeding sites
o Malaria surveillance should be based on weekly reporting and combined with monitoring of
locally important factors regarding the genesis of epidemics, such as meteorological and
environmental conditions and human population movements
o Use screens over doors and windows

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o Biological method
o Eary diagnosis and treatment
o Protective clothes

 Malaria is an important cause of illnesses in Tanzania
 Malaria is a vector-borne disease and it can be cured and prevented using various methods

11. What is malaria?
12. What group of people are more affected by malaria?
13. What diagnostic tests can be done diagnose a patients with malaria?
14. What is first medicine of choice for patients with un-complicated malaria?
15. What is the first medicine of choice for patients with severe malaria?
References
Gordon C Cook, G.C.,& Zumla,A.I (Ed).( 2008). Mansons tropical diseases (22 edition). St. Louis: Elsevier
MOHCGEC(2017). Standard treatment guidelines and national essential medicines list. Dar Es Salaam:
MOHCGEC
WHO(2017). Guidelines for the treatment of malaria (third edition).Geneva: WHO
WHO(2017). World malaria report 2017.Geneva: WHO

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WHO(2018). Fact sheet on malaria. Available at
https://www.who.int/en/news-room/fact-sheets/detail/malaria
SESSION XXX: PROVIDING CARE TO PATIENT WITH PLAGUE
Pre-requisite: none
Learning Tasks
Explain causative agent and vector for plague
Explain epidemiological distribution for plague
NMTOutline clinical features
05211: Management of a patient with
of Communicable plague
Diseases
40
Diagnose plague
Provide to care to patients with plague 40
Explain prevention and control measures for plaque
Resources Needed:
Session Overview

Method
2 20 Presentation/buzzing Causative Agent and Vector of Plague
3 15 Presentation/ Epidemiological Distribution for Plague

brainstorming
4 20 Presentation/ buzzing Clinical Features of a Patient with Plague
5 15 Presentation/ Diagnostic Techniques for Plague
brainstorming
6 20 Presentation/ Care to Patient with Malaria
brainstorming
7 10 Presentation/ Prevention and Control Measures for Plague
brainstorming
8 10
9 05
SESSION CONTENTS

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STEP 2: Causative Agent and Vector of Plaque (20 Minutes)

 ASK a pair of students to mention vector responsible for transmission of plaque.
 Plague (bubonic plague) is an acute infectious disease caused by the organism Yersinia pestis
 Y. pestis is a small Gram-negative coccobacillus
 It is a zoonosis, transmitted mainly by the bite(s) of infected fleas
 Wild rodents are the natural reservoir of Yersinia pestis
 The vector responsible for transmission of plaque from one person to another is infected flea
STEP 3: Epidemiological Distribution for Plaque (15 Minutes)

 ASK each student to mention one continent which is more affected by plaque.
 Plague is still reported consistently from several countries in Africa, Asia and the Americas
 In the decade 19942003 an average of 2850 cases were reported annually to the World Health
Organization (WHO), of which nearly 90% occurred in Africa
 Tanzania is among the countries that are still affected by plaque
 In the USA, a few cases continue to occur every year
 A distinct seasonal pattern is seen and most cases occur in warm dry periods when fleas are most
abundant and humans are most likely to come into contact with the natural hosts
 Notifiable?
STEP 4: Clinical Features of a Patient with Plague (20 Minutes)

 ASK each student to list clinical features of a patient with plaque”.
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42
 The clinical features of plaque are:
o Sudden onset of fever, chills, head and body aches
o Weakness, vomiting and nausea
o Lymphadenitis in the nodes draining the site of a flea bite
 There are 3 forms of plague infection, depending on the route of infection:

o Bubonic: plague is the most common, caused by the bite of an infected flea. Y. pestis, enters at the
bite and travels through the lymphatic system to the nearest lymph node, replicates itself and
causes the lymph node to be inflamed, tense and painful, turning into open sores with pus.
o Septicaemic: plague occurs when infection spreads through the bloodstream, following untreated
bubonic plague causing bleeding, tissue necrosis and shock.
o Pneumonic: plague is the most virulent form and is rare. It is typically caused by spread to the
lungs from advanced bubonic plague. However, any person with pneumonic plague may transmit
the disease via droplets to other humans. Untreated pneumonic plague can be fatal.
STEP 5: Diagnostic Techniques for Plague (15 Minutes)

 ASK each student to list two common tests to diagnose malaria in a patient”.
 Plaque causative agent can be diagnostically identified by using two main techniques:
o Laboratory testing (microscopic examination and culture.): Yersinia pestis is identified by laboratory
testing from a sample of pus from a bubo, blood or sputum.
o Fluorescent antibody or antigen-capture ELISA: A specific Y. pestis antigen can be detected by
Serological tests using fluorescent antibody or antigen-capture ELISA.
STEP 6: Proving Care to Patients with Plague (20 Minutes)

 ASK each student to mention types of care given a patient with un-complicated malaria”.

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 Care of patients with plaque involves giving pharmacological treatment (giving medication)
o Medication of choice is streptomycin
 Streptomycin 30 mg/kg/day (up to a total of 2 g/day) in divided doses IM, to be continued for 10 days of
therapy or until 3 days after the temperature has returned to normal.
 Other antibiotics that can be used to treatment of plaque are
o Tetracycline (250500 mg four times daily, for 10 days) is a satisfactory alternative, especially in
milder cases when an oral drug is required.
o Doxycycline has better in vitro activity23 and is also very effective clinically (adult dose 100 mg
twice daily for 7 days)
STEP 7: Prevention and Control Measures for Plaques (10 Minutes)
mortalities related to plaques:
o Inform people of the presence of zoonotic plague and advised to take precautions against flea
bites
o Do not handle animal carcasses and avoid direct contact with infected body fluids and tissues
o Apply standard precautions when handling potentially infected patients and while collecting
specimens
o Sleeping on bed?
o Health education

 Plaque is still occur in Tanzania
 Plaque is a zoonosis and vector-borne disease
 Plaque can be cured and prevented.

16. What is a plaque?
17. What cause plaque
18. What diagnostic tests can be done diagnose a patients with plaque
19. What is first medicine of choice for patients with plaque?

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44
References
MOHCGEC

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45
SESSION XXX: CARE OF A PATIENT WITH DENGUE
Pre-requisite: none
Learning Tasks
Explain causative agent and vector for dengue
Explain epidemiological distribution for dengue
Outline clinical features of a patient with dengue
Diagnose dengue
Provide to care to patients with dengue
Explain prevention and control measures for dengue

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46
Resources Needed
Session Overview
Method
2 15 Presentation/buzzing Causative Agent and Vector of Dengue
3 15 Presentation/ Epidemiological Distribution for Dengue

brainstorming
4 30 Presentation/ buzzing Clinical Features of a Patient with Dengue
5 15 Presentation/ Diagnostic Techniques for Dengue
brainstorming
6 20 Presentation/ Care to Patient with Dengue
brainstorming
7 10 Presentation/ Prevention and Control Measures for Dengue
brainstorming
8 10
9 05
SESSION CONTENTS

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STEP 2: Causative Agent and Vector of Dengue (15 Minutes)

 ASK a pair of learners to answer the following question: what is dengue fever?
 Dengue is a mosquito-borne viral infection caused by the dengue fever virus

 Man is the main reservoir of the virus
 The vector responsible for transmission of dengue fever from human to human Aedes mosquitoes
through mosquito bites
 Ae. aegypti is the most efficient vectors because of its domestic habits
STEP 3: Epidemiological Distribution for Dengue (15 Minutes)

 Dengue is now endemic in many parts of the world, South and Central America, sub-Saharan Africa,
South and Southeast Asia
 Dengue transmission can occur throughout the year in endemic tropical areas
 However, in most countries there is a distinct seasonal pattern, with increased transmission usually
associated with the rainy season.
 While in some areas increases in dengue transmission coincide with periods of increased rainfall, the
interactions between temperature and rainfall may be important determinants of dengue transmission
STEP 4: Clinical Features of a Patient with Dengue (30 Minutes)

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 ASK each student to list clinical features of a patient with dengue.
 Dengue present in three clinical forms:

o Dengue fever (DF)
o Dengue Hemorrhagic Fever ( DHF)
o Dengue Shock Syndrome (DSS)
 The clinical features of dengue fever are:

o Retro-orbital or ocular pain, headache, rash, myalgia, arthralgia,
o Hemorrhagic manifestations (e.g., positive tourniquet test, petechiae; purpura/ecchymosis;
epistaxis; gum bleeding; blood in vomitus, urine, or stool; or vaginal bleeding)
o Anorexia, nausea, abdominal pain, and persistent vomiting may also occur but are not case-
defining criteria.
 The clinical features of dengue hemorrhagic fever are:

o Persistent high grade Fever lasting from 27 days
o Spontaneous bleeding
o Retro-orbital pain
o Joint, muscle and abdominal pain
o Macular or confluent blanching rash (noted during recovery period)
o Thrombocytopenia (>100,000 cells per mm3)
 The clinical features of dengue sock syndrome. are:

o All criteria for DHF plus circulatory failure as evidenced by rapid and weak pulse and narrow pulse
pressure (<20mm Hg)
o Age-specific hypotension and cold, clammy skin and restlessness
STEP 5: Diagnostic Techniques for Dengue (15 Minutes)

 ASK each student to list two common tests conduct to diagnose malaria in a patient”.

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 Key diagnostic investigations for dengue are:
o Elisa for Dengue NSI antigen
o Serological tests: Dengue IgM & IgG Rapid Strip Test.
o Full blood picture (FBP)
STEP 6: Proving Care to Patients with Dengue (20 Minutes)

 ASK each student to mention types of care given a patient with dengue”.
 There is no specific treatment available for dengue and care is entirely symptomatic and
supportive.
 The following pharmacological care (treatment) should be given to patient with dengue:
o Paracetamol 15mg/kg 8 hourly for 3 days
o Maintainance fluid (Ringers lactate, NS) intravenously if child cannot take enough orally
o Blood transfusion and clotting factors.
o Oxygen and manage hypoglycaemia if present
STEP 7: Prevention and Control Measures for dengue (10 Minutes)
mortalities related to dengue:
o Give health education on dengue covering cause, transmission, clinical features, treatment and
prevention
o Eliminate breeding sites such as water storage, flower vases, old jars, tin, cans and used tyres in
and around human dwellings. This is an effective and definitive method of controlling the vector
and preventing dengue transmission.

 Dengue is still occur in Tanzania
 Dengue is viral and vector-borne disease

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50
 There is no specific treatment for dengue.

 What is a dengue?
 What is the causative agent of dengue?
 What care can be given to patients with dengue?
 How can dengue be prevented and controlled?
References
MOHCGEC

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51
SESSION XXX: CARE OF A PATIENT WITH MENINGITIS
Pre-requisite: none
Learning Tasks
Define meningitis
Identify causes of meningitis
Explain mode of transmission of meningitis
Outline the clinical features of patient with meningitis
Identify diagnostic measures of meningitis
State complications of meningitis
Manage patients with meningitis
Outline preventive and control measures of meningitis
Resources Needed

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52
Session Overview
Method
2 20 Presentation/buzzing Definition and Causes of Meningitis
3 10 Presentation/ Mode of Transmission of Meningitis

brainstorming
4 15 Presentation/ buzzing Clinical Features of Patient with Meningitis
5 15 Presentation/ Diagnostic Measures of Meningitis
brainstorming
6 20 Presentation/buzzing Management of Patient with Meningitis
7 15 Presentation/ Complications of Meningitis

brainstorming
8 10 Presentation/ Prevention and Control Measures for
brainstorming Meningitis
9 10
10 05
SESSION CONTENTS
STEP 2: Definition and Causes of Meningitis (15 Minutes)

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 ASK a pair of learners to answer the following question: what is meningitis?
 Meningitis is an inflammation of the meninges, the protective membranes that surround the brain and
spinal cord
 The inflammation leads to increased cerebrospinal fluid production, which in turn results in increased
intracranial pressure
 Meningitis is caused by many causative agents, which include the following common causes:
o Viruses: Enteroviruses (echo, Coxsackie, polio), Mumps , Influenza, Herpes simplex, Varicella
zoster, and HIV
o Bacteria: Gram-negative bacilli (Escherichia coli, Proteus), group B streptococci, Haemophilus
influenzae Neisseria meningitidis Streptococcus,
o Fungi: Cryptococcus neoformans , Candida, Histoplasma
o Toxins: lead, arsenic
o Non-infective (sterile): Breast cancer, bronchial cancer, leukaemia and lymphoma
STEP 3.Mode of Transmission of Meningitis(10 Minutes)


Common causative agents (viruses and bacteria) for meningitis can be transmitted from one person to
another commonly by:
o Airborne route transmission: e,g through sneezing or coughing,

o Direct contact: direct contact with nasal pharyngeal secretions
STEP 4: Clinical Features of a Patient with Menigitis (15 Minutes)

 ASK each student to list clinical features of a patient with meningitis.
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 Patient with meningitis present with the following clinical feature:
o Pyrexia,
o Headache
o Photophobia
o Stiffness of the neck
o Vommitting
o Seizure
o Comma
STEP 5: Diagnostic Techniques for Meningitis (15 Minutes)

 ASK each student to list two common tests that can be conducted to diagnose a patient with
Meningits”.
  Key diagnostic
CLARIFY andinvestigations
summarize by forusing
meningitis are: below
the content
o Lumber puncture with cerebrospinal fluid culture
o CT scan to rule out other causes
o Blood tests
o Blood culture
STEP 6: Proving Care to a Patient with Meningitis (20 Minutes)

 ASK each student to mention types of care that can be given to patient with meningitis”.
 There is no specific treatment for viral meningitis

 the condition is usually benign and self-limiting
 The patient should be treated symptomatically in a quiet environment
 Two types of care are given to patient with meningitis

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o Supportive care: which include control of fever and pain ,control convulsions and If unconscious,
insert NGT for feeding and urethral catheter
o Pharmacological care: medications should be given to patients depending on cause
o medications may include the following:
 Antibiotics: Chloramphenicol, Benzyl penicillin , Ceftriaxone, Ampicillin., Cefotaxime
 Anti-virals
 Anti-fungals
 Anti-pyretics
 Anti-convulsants
STEP 7: Complications of Meningitis (15 minutes)

 The following are complications of meningitis:
o Increased intracranial pressure
o Cerebral infarction
o endocarditis
STEP 8: Prevention and Control Measures for Meningitis (10 Minutes)
mortalities related to meningitis:
o Give health education covering cause, transmission, clinical features, treatment and prevention
o Ovoid overcrowding
o Reduce social contact, particularly in crowded places
o Encourage people not to cough directly at people
o Give Chemoprophylaxis to close contacts
o Give vaccines to children

 Meningitis is still an important health problem globally and in Tanzania
 Meningitis has many causes, which influence the management of patients
 Meningitis has typical presentation which can be used to identified patients

 What is meningitis?
 What are the causative agents of meningitis?

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 What are the clinical features of patient with meningitis
 What care can be given to patients with meningitis?
References
MOHCGEC

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SESSION XXX: PROVIDING CARE TO PATIENT WITH MEASLES AND
MUMPS
Pre-requisite: none
Learning Tasks
Define measles and mumps
Identify types of measles
Describe mode of transmission of measles and mumps
Outline the clinical features of a patient with measles and mumps
Outline complications of measles and mumps
Manage patients with measles and mumps
Explain preventive and control measures of measles and mumps

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Resources Needed:
Session Overview

Method
2 20 Presentation/buzzing Definitions of Measles and Mumps
3 Presentation/ Types of Measles

brainstorming
4 10 Presentation/ Mode of Transmission of Measles and Mumps
brainstorming
4 15 Presentation/ buzzing Clinical Features of Patient with Measles and
Mumps
6 20 Presentation/buzzing Management of Patient with Measles and
Mumps
7 15 Presentation/ Complications of Measles and Mumps

brainstorming
8 10 Presentation/ Prevention and Control Measures for Measles
brainstorming and Mumps
9 10
10 05
SESSION CONTENTS

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STEP 2: Definition Measles and Mumps (15 Minutes)

 ASK a pair of learners to answer the following question: what is measles?
Mumps
 Mumps is a viral infection of the salivary glands producing enlargement and pain in the parotid gland,
but can lead to orchitis, mastitis, meningitis, pancreatitis and acute respiratory symptoms
 Commonly an infection of children 25 years of age, the more serious manifestations are more likely in
adults, especially males.
 The virus is transmitted via direct contact or by droplets spread by the airborne route. Any contact of
saliva, such as sharing of cutlery, wiping the mouth with a common cloth, or kissing, can result in
transmission.
Measles
 Measles is an acute, highly communicable infectious disease caused by Measles virus

 Measles remains a leading vaccine-preventable cause of child mortality worldwide, particularly in sub-
Saharan Africa where
 Measles is one of the most prevalent infectious diseases of the tropics, and certainly one of the most
serious of the acute childhood communicable illnesses
 The mode of transmission is airborne, by droplet spread through coughing or sneezing, or by direct
contact with nasal or throat secretions of infected persons
STEP 3.Types of Measles (10 Minutes)

 ASK each student to answer the following question: what are the types of measles?

NO TYPES?

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STEP 4. Mode of Transmission of Measles and Mumps (10 Minutes)
Mumps
 The virus is transmitted via direct contact or by droplets spread by the airborne route
o Any contact of saliva, such as sharing of cutlery, wiping the mouth with a common cloth, or
kissing, can result in transmission.
Measles
 Measles is one of the most contagious of infections; approximately 90% of susceptible individuals will
contract the disease after contact with a case.
 Transmission is direct, from secretions from the respiratory tract by droplet spread. Cases are
infectious only in the early stages, when virus can be isolated from the throat.
STEP 4: Clinical Features of a Patient with Menigitis (15 Minutes)

 ASK each student to list clinical features of a patient with measles and mumps.
Mumps
 An acute viral disease characterized by fever, swelling and tenderness of one or more salivary glands,
usually the parotid and sometimes the sublingual or submaxillary glands
 Swelling of the salivary glands occurs in up to 95% of all symptomatic cases.
 A moderate febrile response is present at the time of the disease onset
Measles
 Clinical features of measles are:
o Generalized, reddish (erythematous), blotchy (maculopapular) rash;
o History of fever usually above 38˚C (if not measured, then "hot" to touch);
o Dry cough; Sore throat; Runny nose (coryza);
o Inflamed eyes (conjunctivitis), tiny white spots with bluish-white centers on a red background found
inside the mouth on the inner lining of the cheek- also called Koplik's spots.
o In addition, children with measles frequently exhibit a dislike of bright light (photophobia), and often
have a sore red mouth (stomatitis).

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STEP 6: Providing Care to Patients with Meningitis (20 Minutes)

 ASK each student to mention types of care that can be given to patient with measles”.
Measles care
 No specific anti-viral treatment exists for measles virus
 Care of patient with measles includes the following:

o Adults: Paracetamol tablets 1g every 8 hours for 5 days and Vitamin A 200000 IU orally, stat
o In case of ocular involvement, add Oxytetracycline eye ointment 1% apply once daily for 7 days
o Children: Paracetamol 1015mg/kg body weight every 8 hours for 5 days and Vitamin A if less
than 1 year give 100000 IU stat and if over 1 year give 200000 IU
o Supportive care, example good nutrition, fluid intake
o Antibiotic therapy is reserved for bacterial infections like pneumonia, ear infections
Mumps care
Cares of patient with mumps include the following:
o Symptomatic care: giving paracetamol
o Antibiotic therapy is reserved for bacterial complications
STEP 7: Complications of Mumps and Measles (15 minutes)
Mumps
 The following are complications of Mumps:
o Orchitis,
o Symptomatic aseptic meningitis
o Mumps encephalitis
Measles
The following are complications of measles:
o Otitis media
o Encephalitis
o Severe diarrhoea
o Severe respiratory infection
o Blindness

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STEP 8: Prevention and Control Measures for meningi (10 Minutes)
Measles
 Prevention and control of measles should include:
o Giving health education
o Giving routine measles vaccination for children combined with mass immunization campaigns
o Keeping Children out of school for 4 days after appearance of the rash
o Giving Immunization of contacts using live virus vaccine within 72 hours of exposure.
Mumps
Prevention and control of mumps include the following:
o Giving health education should encourage mumps immunization
o Giving measles-mumps- rubella (MMR) vaccination
o Disinfect articles soiled with nose and throat secretions.

 Measles and mumps are still important health problems globally and in Tanzania
 Measles and mumps are have clinical features which are useful indicators for diagnosing these
diseases
 There are no specific medications for treatment for measles and mumps

 What is measles?
 What is causative agent of mumps?
 What are the clinical features of patient with mumps and measles
 What care can be given to patients with measles?

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References
Gordon C Cook, G.C.,& Zumla,A.I (Ed.).( 2008). Mansons tropical diseases (22 edition). St. Louis: Elsevier
MOHCGEC
Walker, B. R., Colledge, N. R., Ralston, S. H.& Penman, I D. ( 2014). Principles and practices of medicine.
Edinburgh: Elsevier

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SESSION XXX: CARE TO PATIENT WITH TUBERCULOSIS AND LEPROSY
Pre-requisite: none
Learning Tasks
At the end of this session, a learner is expected to be able to:
Define TB and leprosy
Outline the causes of TB and Leprosy
Identify types of TB and leprosy
Explain the magnitude of TB and Leprosy
Explain risk factors contributing to TB and Leprosy infection and disease
Describe transmission of TB and leprosy
Outline the clinical features of a patient with TB and leprosy
NMTManage
05211: Management of Communicable
patients with Diseases
TB and leprosy 65
Outline complications of TB and Leprosy
Explain prevention and control measures of TB and leprosy 65
Resources Needed:
Session Overview

Method
2 10 Presentation/buzzing Definitions and Causes of TB and leprosy
3 10 Presentation/brainstorming Types of TB and leprosy
4 10 Presentation Magnitude of TB and Leprosy
5 15 Presentation/ buzzing Risk Factors Contributing to TB and

Leprosy
6 10 Presentation Mode of Transmission of TB and Leprosy
7 15 Presentation/ buzzing Clinical Features of Patient with TB and

Leprosy
8 20 Presentation/buzzing Management of Patient with TB and leprosy
9 05 Presentation/ brainstorming Complications of TB and Leprosy
10 10 Presentation/ brainstorming Prevention and Control Measures for TB

and Leprosy
11 05
12 05

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SESSION CONTENTS
STEP 2: Definition TB and Leprosy (10 Minutes)

 ASK a pair of learners to answer the following question: what is TB?
Tuberculosis (TB)
 Tuberculosis (TB) is a bacterial and chronic airborne infectious disease
 The causative organism of tuberculosis is Mycobacterium tuberculosis, which is tubercle bacilli are
aerobic, non-motile, and non-sporing bacteria
Leprosy
 Leprosy is a chronic granulomatous disease that affects mainly the skin, the peripheral nerves and the
mucous membranes
 The causative organism of tuberculosis is Mycobacterium leprae
STEP 3: Types of TB and Leprosy (10 Minutes)

 ASK each student to mention types of TB

Tuberculosis
 There are two main types of tuberculosis based on the clinical manifestations, these are:

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o Pulmonary Tuberculosis (PTB)
o Extra-Pulmonary Tuberculosis (EPTB)
Pulmonary Tuberculosis (PTB)

 This is the commonest form that affects the lungs and is the infectious form of the disease;
 Pulmonary tuberculosis can be:
o Tuberculosis sputum positive
 Patient whose sputum for acid fast bacilli (AFB) is positive out of three sputum specimens
 Chest X-ray suggestive PTB
o Tuberculosis sputum negative
 All three patients sputum specimen are negative and does not respond to broad spectrum
antibiotics
 Suggestive signs of TB
Extra-Pulmonary Tuberculosis (EPTB)

 This is the form that affects any other part of the body or organs e.g. pleura, lymph node pericardium,
spine, joints, abdomen or genito-urinary tract.
 Extra-Pulmonary Tuberculosis (EPTB) occurs in two forms:
o Severe form, which is characterised by:
 Tb meningitis
 Milliary TB
 TB peritonitis
 TB of the spines
 Bilateral pleural effusion TB
 Genital urinary TB
 TB pericarditis
o Less severe form, characterised by:

 Unilateral pleural effusion TB
 TB of joint
 TB of bones
 TB adenitis
Leprosy
 Leprocy occurs in two types:
o Multibacillary (MB) Leprosy, which is characterised by:
 Patients with six or more leprosy skin lesions
 Positive skin smear
o Paucibacillary (PB) Leprosy, which is characterised by:
 Patients with one to five leprosy skin lesions
 Negative skin smear
STEP 4. Magnitude of Tuberculosis and Leprosy (10 Minutes)

Tuberculosis

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 Tuberculosis is one of the top 10 causes of death worldwide
 In 2017, 10 million people fell ill with TB, and 1.6 million died from the disease (including 0.3 million
among people with HIV).
 In 2017, an estimated 1 million children became ill with TB and 230 000 children died of TB (including
children with HIV associated TB).
 TB is a leading killer of HIV-positive people
 Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk.
 Over 95% of cases and deaths occur in developing countries
 People who are infected with HIV are 20 to 30 times more likely to develop active
 Tobacco use greatly increases the risk of TB disease and death
 In 2017, the largest number of new TB cases occurred in the South-East Asia and Western Pacific
regions, with 62% of new cases, followed by the African region, with 25% of new cases.
 In 2017, 87% of new TB cases occurred in the 30 high TB burden countries.
 Eight countries accounted for two thirds of the new TB cases: India, China, Indonesia, the Philippines,
Pakistan, Nigeria, Bangladesh and South Africa
 Data in Tanzania??
Leprosy
 Accurate information on leprosy is difficult to obtain, considering delays in diagnosis caused by the
insidious onset of disease and fear of stigmatization, inaccuracies in treatment registry data, and
incompleteness of reporting, particularly in regard to disability caused by leprosy
 Almost 300 000 new cases of leprosy were reported in 2005, the vast majority occurring in South and
Southeast Asia, South America and Africa, and nearly 220 000 were registered on treatment on 31
December, 2005
 A total of 115 countries reported on leprosy in 2005, among which India, Brazil, Indonesia, Democratic
Republic of the Congo, and Bangladesh reported the newest leprosy cases.
 Leprosy prevalence, measured in cases registered for treatment per 10 000 population, was highest in
Mozambique, Nepal, Democratic, Republic of the Congo, Brazil, Tanzania and Madagascar
 In 2016, there were 216, 108 new leprosy cases registered globally from 145 countries from the 6
WHO Regions, including Africa
 In 2015, Indian was a home of 60% of all new cases detected reported to WHO.
 In 2015, there 2,256 new leprosy cases detected in Tanzania and reported to WHO
STEP 5. Risk Factors Contributing to TB (15 Minutes)

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 ASK each student to mention risk factors forTB
Tuberculosis
 The risk factors for developing TB are as follows:
o Age: below 5 years and old age
o Immune suppression : related to HIV infection, protein-calorie malnutrition, steroid therapy,
cytotoxic drugs, congenital immune-deficiencies, and vitamin D deficiency
o Medical conditions: liver failure, cancer, diabetes mellitus, smoking-related lung damage,
industrial dust disease of the lungs- e.g. Silicosis, asbestosis, renal failure, measles,
schistosomiasis, and gastrectomy
o Stress: lead to excess corticosteroid production
o Environmental factors: Exposure to populations of environmental mycobacteria:
overcrowding
o Mycobacterial factors: strain variation in virulence
STEP 6. Mode of Transmission of TB and Leprosy (10 Minutes
Tuberculosis
 TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit,
they propel the TB germs into the air.
 A person needs to inhale only a few of these germs to become infected
Leprosy
 The method of transmission has not been conclusively demonstrated, but several factors such as
prolonged close contact, the finding of large numbers of bacilli in the nasal discharges of lepromatous
cases and in the skin, suggest that both airborne and direct skin contact are important.

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STEP 7: Clinical Features of a Patient with TB and Leprosy (15 Minutes)

 ASK each student to list clinical features of a patient with TB.
Tuberculosis
 Clinical features (signs and symptoms) of tuberculosis include the following:
o Cough of more than two weeks
o Fever
o Excessive night sweats
o Haemoptysis (sputum mixed with blood stains)
o Loss of weight
o Loss of weight
o Fatigue (tiredness)
o General malaise
o Others includes swelling of lymph nodes, ascites, difficulty in breathing, swelling of joints etc.,
depending on the site of the disease
Leprosy
 The following are clinical features of leprosy:

o Hypo pigmented anaesthetic macula or nodular and erythematous skin lesions
o Nerve thickening.
o Burning sensations in the skin
o Numbness and tingling of the feet and/or hands
o Weakness of eyelids, hands or feet
o Painless swellings or lumps in the face and earlobes
o Painless wounds or burns on the hands or feet
 The three cardinal signs of leprosy are the following:

o Skin patch with loss of sensation
o One or more enlarged peripheral nerves
o Presence of leprosy bacillipositive smear

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STEP 8: Providing Care to Patients with TB and Leprosy (20 Minutes)

 ASK each student to mention medicines used for treatment of patients with TB”.
Tuberculosis
 Care (treatment) of TB patient has two phases:
o Initial /intensive phase, which consists of:
 RHZE for 2 months for new case AND
 SRHZE for 2 months then
 RHZE 1month for re-treatment case.
o Continuation phase, which consists of:
 RH for 4 months for new patient AND
 RHE 5 months for re-treatment case
 The combination of medicines is indicated in table below
Table. The recommended first-line anti-TB medicines for adults and children
New/Retreatments Initial Phase Continuation Phase
New treatment Rifampicin + Isoniazid + Rifampicin + Isoniazid (RH) for 4

Pyrazinamide and Ethambutol in months
fixed dose (RHZE) for 2 months
Retreatments Streptomycin+ Rifampicin + Rifampicin + Isoniazid+
Isoniazid + Pyrazinamide and Ethambutol (RHE) for 5 months.
Ethambutol for 2months then
RHZE for 1months
 Details on medicines and their dosage for adults and children are indicated in the Standard Treatment
Guidelines for Tanzania
Leprosy
 Patients are treated by multidrug combination therapy; dosage may depend with classification and
whether patient is adult or children
 The medicines and dosage are indicated in table below.
Classification Medicine dosage Duration of treatment

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Adult MB: 15 years and Day 1: Rifampicin 600mg (2x 300mg) + 12 blister packs to be taken
above Clofazemine 300mg (3 x 100mg) + Dapsone within a period of between
100mg. Daily Treatment: Day 228, 1218 months
Clofazemine 50mg + Dapsone 100mg
Child MB: below 15yrs Day 1: Rifampicin 450mg (3 x 150mg) + 12 blister packs to be taken
Clofazemin 150mg (3 x 50mg) + Dapsone within a period of between
50mg. Daily Treatment: Day 228 1218 months
Clofazemine 50mg every other day +
Dapsone 50mg daily.
Adult PB: 15 years and Day 1: Rifampicin 600mg (2 x 300mg) + 6 blister packs to be taken
above Dapsone 100mg. Daily Treatment: Days 228: within a period of between
Dapsone 100mg 69 months
Child PB: below 15yrs Day 1: Rifampicin 450mg (3 x 150mg) + 6 blister packs to be taken
Dapsone 50mg. Daily Treatment: Days 228: within a period of between
Dapsone 50mg daily 69 months
STEP 9: Complications of Mumps and Measles (5 minutes)
TB
 The following are complications of Mumps:
o Tuberculous meningitis
o Bones and joints infection
o Renal tract infection
Leprosy
 The following are complications of measles
o Skin damage
o Nerves damage
o Infertility
o Glomerulonephritis,
o Bone damage
o blindness
STEP 10: Prevention and Control Measures for TB and Leprosy (10 Minutes)
TB
 The following should be done to prevent and control TB:
o Give Health education on causes, transmission, care and prevention
o Early case finding and proper treatment

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o Contact case tracing and treatment
o Giving BCG vaccine to all new-born babies and under five children
o Proper boiling of milk
o Adhering to principles of standard precautions of infection prevention and control when dealing
with TB patients
o Case holding those who are put on treatment, should be maintained on treatment until they
finish the whole course of treatment.
o Strengthening the efficiency and reliability of the health services
o TB patients should be advised not to spit anywhere carelessly.
o A sputum container filled with sand should be used to spit.
o The sputum should be disposed carefully in a pit latrine and the soiled mug thoroughly
disinfected, washed and dried if possible in bright sunlight..
o Overcrowding and poor ventilation at homes should be avoided
o Patients should cover their mouth with a piece of cloth during coughing to reduce distributing
particles to the air.
Leprosy
 Prevention and control measures for leprosy include the following:
o Give Health education on causes, transmission, care and prevention
o Early diagnosis and prompt treatment with multi-drug treatment approach
o Contact case tracing and treatment
o Case holding and patient drug compliance
o Avoid overcrowding and improve ventilation
o Early detection of leprosy reactions and prompt treatment with prednisolone

 Tuberculosis and leprosy are still important health problems globally and in Tanzania
 Both Tuberculosis and leprosy have clinical features which are useful indicators for diagnosing these
diseases
 Both Tuberculosis and leprosy can be prevented and cured

 What is tuberculosis?
 What is causative agent for tuberculosis and leprosy?
 What are the clinical features of patient with tuberculosis and leprosy

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 What care can be given to patients with tuberculosis?
References
Gordon C Cook, G.C.,& Zumla,A.I (Ed.).( 2008). Mansons tropical diseases (22 edition). St. Louis: Elsevier
MOHCGEC
Walker, B. R., Colledge, N. R., Ralston, S. H.& Penman, I D. (2014). Principles and practices of medicine.
Edinburgh: Elsevier

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75
WHO (2016). Weekly epidemiological record. Available at
http://apps.who.int/iris/bitstream/handle/10665/249601/WER9135.pdf;jsessionid=A4D403C8FAE95
ABFFCE736150308BE65?sequence=1
WHO (2018). Fact sheet on leprosy. Available at
https://www.who.int/en/news-room/fact-sheets/detail/leprosy
WHO (2018). Fact sheet on Tuberculosis. Available at
https://www.who.int/en/news-room/fact-sheets/detail/tuberculosis
SESSION XXX: PROVIDING CARE TO PATIENT WITH HIV RELATED

OPPORTUNISTIC INFECTIONS
Learning Tasks
Pre-requisite: none
Define opportunistic infections
Identify people living with HIV and AIDS
Explain common HIV related opportunistic infections 76
Manage people living with HIV and AIDS
76
Resources Needed:
Session Overview

Method
2 10 Presentation/buzzing Definition of Opportunistic Infections
3 25 Presentation/brainstorming Identification of People Living with HIV and

AIDS (PLWHIV/AIDS)
4 30 Presentation Common HIV related Opportunistic
Infections
5 25 Presentation/ buzzing Management of People Living with HIV
and AIDS
6 10
7 05
SESSION CONTENTS

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STEP 2: Definition of Opportunistic Infections (10 Minutes)

 ASK a pair of learners to answer the following question: what are opportunistic infections?
 Opportunistic Infections( OIs) are illnesses caused by various organisms, some of which usually do not
cause disease in persons with healthy immune systems.
 Opportunistic infections are defined as infections that are more frequent or more severe because of
immunosuppression in HIV-infected person.
STEP 3. Identification of People Living with HIV and AIDS (25 Minutes)

 ASK each student to define the term people living with HIV

People living with HIV (PLWHIV/AIDS)

 People leaving with HIV are people who have been infected with HIV, which can be categorised into
two main groups:
o People living with HIV with known HIV-status: diagnosed through HIV testing
o People living with HIV with unknown HIV-status: HIV testing has not been done
 People living with HIV have may be asymptomatic or symptomatic
 People living with HIV include adults and children
 There were approximately 36.9 million people living with HIV at the end of 2017 with 1.8 million people
becoming newly infected in 2017 globally.
 In Tanzania by 2016, it was estimated that around 1.35 million people were infected with HIV in the
country.
 People living with HIV can be identified or diagnosed by
o HIV-testing- this is most reliable way of identifying people with HIV
o Syndromic approach: this done using signs and symptoms that people living with HIV may
have

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People affected with HIV
 People affected by HIV encompasses family members and dependents who may be involved in
caregiving or otherwise affected by the HIV-positive status of a person living with HIV.
STEP 4. Common HIV Related Opportunistic Infections (30 Minutes)

 OIs continue to cause considerable morbidity and mortality for three primary reasons:
o Many patients are unaware of their HIV infection and seek medical care when an OI becomes the
initial indicator of their disease;
o Certain patients are aware of their HIV infection, but do not take ART because of psychosocial or
economic factors; and
o Certain patients are prescribed ART, but fail to attain adequate virologic and immunologic
response because of factors related to adherence, pharmacokinetics, or unexplained biologic
factors
 OIs and HIV infection have a bidirectional relationship:
o HIV causes the immunosuppression that allows opportunistic pathogens to cause disease in
HIV-infected persons.
o OIs can adversely affect the natural history of HIV infection by causing reversible increases in
circulating viral load that could accelerate HIV progression and increase transmission of HIV.
o The reduced progression of HIV infection would reduce the risk of subsequent OIs.
 There are many opportunistic infections that occur to a person with HIV, which include the following:
o Bacterial Respiratory Disease: caused by Streptococcal pneumoniae, Haemophilius influnenzae,
TB (very common)
o Bacterial Enteric Infections
o Protozoan conditions:
 Toxoplasmosis
 Cryptosporidiosis
o Fungal conditions:
 Candidiasis- oral pharyngeal, Oesophageal Candidiasis, Vaginal candidiasis
 Cryptococcal meningitis, major cause of meningitis in people living with HIV;
 Pneumocystic Jiroveci (PJP
 Pneumocystic Jiroveci (PJP)
o Viral conditions:
 Herpes Simplex Virus Disease
 Varicella-Zoster(Shingles) Virus Diseases
 Human Papilloma Virus Infection
o Skin conditions:
 Scabies
 Seborrheic Dermatitis
 Kaposis sarcoma

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 Further details of clinical presentation and specific management for each condition mentioned above
are given in the current Tanzania HIV/AIDS management guidelines
Prepare handout for Refer students

STEP 5. Management of PLW HIV/AIDS (25 Minutes)

 ASK each student to mention care that can be given to people living with HIV/AIDS
 People living with HIV can be managed using various interventions/treatment such as:
o HIV counseling and testing: giving HIV and testing services
o Laboratory services: giving laboratory services diagnosis and monitoring treatments
o Preventive services: giving health education, condom
o Screen of diseases: screening diseases that commonly affect people living with HIV/AIDS: e.g.
cervical cancer, sexually transmitted diseases
o Family planning services: giving family planning services according to need of the client
o Management of Opportunistic infections: giving various treatments for Opportunistic infections

needed by each client; e.g. giving prophylactic treatment using Cotrimoxazole, Isoniazid
o PMTCT services: proving care for prevention of mother-to child- transmission HIV
o Antiretroviral Therapy: giving ARV according to needs of the patients and in line with HIV/ADIS
treatment guidelines
o Mental health services: providing mental services needed by each clients
o Pre-referral and referral services: provide pre-referral and referral services
o Supportive services: Link clients to supportive service providers and organizations

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 HIV continues to be a major global public health issue in Tanzania and globally
 There are many people living with HIV and who are also affected by various opportunistic infections
 People living with HIV need various care from health professionals and others

 What are opportunistic infections?
 What the examples of opportunistic infections?
 How can people living HIV be identified?
References
MOHCGEC
MOHSW(2013) Facilitators for HIV and AIDS module.Dar Es salaam: MOHSW
National AIDS Control Programme(2017). National guidelines for the management of HIV and AIDS (6
edition). Dar es salaam: National AIDS Control Programme.
National Institutes of Health, Centers for Disease Control and Prevention (2015).Guidelines for prevention
and treatment of opportunistic infections in HIV-infected adults and adolescents. Available at
https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
UNAIDS (2011).UNAIDS terminology guidelines. Available at
http://www.unaids.org/sites/default/files/media_asset/JC2118_terminology-guidelines_en_1.pdf
WHO( 2018) Fact sheet on HIV. Available at https://www.who.int/en/news-room/fact-sheets/detail/hiv-aids

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SESSION XXX: CONCEPTS OF INTEGRATED MANAGEMENT OF ADULT
AND ADOLESCENT ILLINESSES
Pre-requisite: none
Learning Tasks
Define Integrated Management of Adult and Adolescent Illness (IMAI)
Outline the advantages and disadvantages management of adult and adolescent illness (IMAI)
HIV and AIDS diagnosis
NMTOutline the steps in of
05211: Management management of Diseases
Communicable emergency in IMAI
Explain principles of chronic care in IMAI package 82
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Resources Needed
Session Overview

Method
2 10 Presentation/buzzing Definition of Integrated Management of

Adult and Adolescent illness (IMAI)
3 5 Presentation/brainstorming Advantages and Disadvantages Integrated
Management of Adult and Adolescent
Illness (IMAI)
4 15 Presentation Steps in Management of Emergency in
IMAI
5 15 Presentation/ buzzing Principles of Chronic Care in IMAI Package
6 05
7 05
SESSION CONTENTS

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STEP 2: Definition of Integrated Management of Adult and Adolescent illness (IMAI)
(10 Minutes)

 ASK a pair of learners to answer the following question: what is integrated management of adults and
adolescent illness?
 Integrated Management of Adult and Adolescent Illness (IMAI) is a strategy to improve the quality of
health care for under-served populations in low resource settings.
 The strategy covers the following issues:
o Chronic HIV and TB basic care with ARV therapy
o Acute care
o Palliative care
o General principles of good chronic care
 IMAI is designed to better meet the health care needs of adolescents and adults, through improved
case management, disease prevention and health promotion
 The basic ART clinical training course is intended for health care workers at health centers and
dispensaries in rural or urban areas in low resource settings, including:
o Clinical Officers
o Clinical Assistants
o Nurses
STEP 3. Advantages and Disadvantages Integrated Management of Adult and
Adolescent Illness (IMAI) (5 Minutes)

 ASK each student to list advantages and disadvantages of IMAI”

The advantages of IMAI

 IMAI is appropriate and important set of interventions to improve prevention and care for adolescents
and adults including the elderly, in low resource settings, particularly at first-level facilities using an
integrated and syndromic approach
 IMAI integrate important but neglected non-communicable disease problems such as mental health
disorders, in particular depression.
 IMAI enable health workers to provide acute, chronic , and palliative care in an integrated manner

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Disadvantages???
STEP 4. Steps in Management of Emergency in IMAI (15 Minutes)

 In emergency, IMAI steps to be followed are as follows:
1) Quickly check for emergency signs: this step involves doing the following:
 Checking for airway and breathing circulation (shock)
 Calling for help and begin providing the emergency treatment if any positive sign is present
2) Assess acute illness: determine if the patient has acute illness by:
 Asking why did you come for this consultation? Ask further for
coughing or difficult breathing
 Checking for under nutrition and anaemia
 Looking in the mouth for mouth/throat problems
 Asking about pain; If patient is in pain, grade
 Requesting laboratory tests if needed
3) Classify: classify the condition of the patients: e.g. severe pneumonia, severe under malnutrition
4) Identify the treatments: this step involving:
 listing the treatments required for each condition or disease
 providing needed treatment
 providing advice and counseling
5) Consider HIV-related conditions: this steps involves
 Checking for HIV-related condition in patient after attending acute conditions
 Providing treatment related to HIV conditions
6) Prevention: consider needs and provide screening and Prophylaxis to clients who need them
7) Make follow-up for acute illness: make follow up for all patients with acute illness or condition
STEP 5. Principles of Chronic Care in IMAI Package (15Minutes)

 ASK each student to mention principles for chronic care
 The following are good principles of chronic care:

o Develop a treatment partnership with your patient.
o Focus on your patients concerns and priorities: address main concern of the clients
o Use the 5 As: Assess, Advise, Agree, Assist and Arrange.

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o Support patient self-management: educate, empower and help the patient to manage his
condition or disease
o Organize proactive follow-up: proactively make follow up of the client health status
o Involve expert patients, peer educators and support staff in your health facility.
o Link the patient to community-based resources and support: link the client with resources and
support found the community
o Use written informationregisters, treatment plan, treatment cards and written information for
patientsto document, monitor and remind.
o Work as a clinical team: work with other provide needed care by the client
o Assure continuity of care: continuously improve quality of care of the clients based on feedback
and condition of the client
REFER STUDENTS TO HANDOUT:
 In using 5As ( Assess, Advise, Agree, Assist and Arrange), the the following should be done by a
health professional:

 Integrated management of adult and adolescent Illness is useful strategy for acute, chronic and
palliative care
 The principles chronic care and steps for acute are useful guidelines for providing and improving care
STEP 6: Session Evaluation ( 5 minutes)
 What is an integrated management of adult and adolescent Illness (IMAI)?
 What are the advantages of IMAI?
 List four good principles of chronic care
References

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WHO(2004).Integrated management of adult and adolescent Illness: General principles of good chronic
care: Geneva: WHO
WHO(2004).Integrated management of adult and adolescent Illness: Acute care: Geneva: WHO
WHO( 2003) Integrated management of adolescent and adult illness (IMAI). Geneva: WHO
References
MOHCGEC
MOHSW(2013) Facilitators for HIV and AIDS module.Dar Es salaam: MOHSW
National AIDS Control Programme(2017). National guidelines for the management of HIV and AIDS (6
edition). Dar es salaam: National AIDS Control Programme.
National Institutes of Health, Centers for Disease Control and Prevention (2015).Guidelines for prevention
and treatment of opportunistic infections in HIV-infected adults and adolescents. Available at
https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
UNAIDS (2011).UNAIDS terminology guidelines. Available at
http://www.unaids.org/sites/default/files/media_asset/JC2118_terminology-guidelines_en_1.pdf
WHO( 2018) Fact sheet on HIV. Available at https://www.who.int/en/news-room/fact-sheets/detail/hiv-aids
REFER STUDENTS TO HANDOUT:

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 In using 5As ( Assess, Advise, Agree, Assist and Arrange), the the following should be done by a
health professional:
o Assess
 Assess patients goals for this consultation.
 Assess patients clinical status, classify/identify relevant treatments and/or advise and
counsel. Assess risk factors.
 Assess patients knowledge, beliefs, concerns, and daily behaviours related to his/her
chronic condition and its treatment.
o Advise
 Use neutral and non-judgmental language.
 Correct any inaccurate knowledge (as assessed above) and complete gaps in the patients
understanding of his/her conditions and/or risk factors and their treatments.
o Agree
 Negotiate selection from the diff erent options.
 Agree upon goals that refl ect patients priorities. Ensure that the negotiated goals are:
 Clear.
 Measurable.
 Realistic.
 Under the patients direct control.
 Limited in number
o Assist
 Provide a written or pictorial summary of the plan.
 Provide treatments.
 Provide medication (prescribe or dispense).
 Provide other medical treatments.
 Provide skills and tools to assist with self-management and adherence.
 Provide adherence equipment (e.g., pill box by day of week)
 Address obstacles.
 Provide psychological support as needed.
 Link to available support
Arrange
 Arrange follow-up to monitor treatment progress and to reinforce key messages.

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SESSION 07: CARE OF PATIENTS WITH RABIES AND TETANUS
Prerequisite: None
Learning Tasks
At the end of this session learners are expected to be able to:
Define rabies and tetanus
Explain the mode of transmission of rabies
Outline the clinical features of a patient with rabies
Manage patients with rabies
Outline complications of rabies
Enumerate preventive measures of rabies
Explain the mode of transmission of tetanus
Outline the clinical features of a patient with tetanus
Manage patients with tetanus
Outline complications of tetanus
Enumerate preventive measures of tetanus

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Resources Needed
Session Overview
Step Time (min) Activity/Method Content
1. 05 Presentation Session title and learning tasks

2. 05 Buzzing Definition of rabies and tetanus
Lecture/Discussion
3. 05 Lecture/Discussion Mode of transmission of rabies
4. 05 Lecture/Discussion Clinical features of a patient with rabies
5. 35 Lecture/Discussion Management of a patient with rabies
6. 05 Lecture/Discussion Complications of rabies
7. 05 Lecture/Discussion Preventive measures of rabies
8. 05 Lecture/Discussion Mode of transmission of tetanus
9. 10 Lecture/Discussion Clinical features of a patient with tetanus
10. 15 Lecture/Discussion Management of a patient with tetanus
11. 05 Brainstorming Complications of tetanus
Lecture/Discussion
12. 05 Lecture/Discussion Preventive measures of tetanus
13 05 Presentation Key points
14. 05 Presentation Session Evaluation

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SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (05 Minutes)
STEP 2: Definition of Rabies and Tetanus (05 Minutes)

ACTIVITY: Buzzing (02 minutes)
ASK students to pair up and buzz on definitions of rabies and tetanus

ALLOW 2 to 3 students to provide responses and let others provide additional
responses
WRITE their responses in the chalk/white board or flip chart
 CLARIFY
Rabies and
is a viral disease their
summarize of animal transmitted
responses to human
using throughbelow
the content a bite of a rabid domestic or wild animal
 Tetanus is a serious disease caused by a bacterium Clostridium tetani affecting nervous system, leading to
painful muscle contractions, particularly of jaw and neck muscles
STEP 3: Mode of Transmission of Rabies (05 Minutes)

The animals spreading the disease include:
 Wild animals
o Jackals
o Hyenas
o Bats
 Domestic animals
o Dogs, cats
o Horses
o Donkeys
 Sometimes the domestic animals are infected by wild animals e.g. cats.
Mode of transmission of rabies;

 Human become infected when bitten by a rabid animal usually a dog or hyena
o Saliva left in the wound after animal bite contain virus which find its way to the brain via the nerves
STEP 4: Clinical Features of a Patient with Rabies (05 Minutes)

There are two clinical manifestations of rabies frantic and paralytic. Frantic rabies is most common form of human
rabies
 Incubation period depends on the size of the bite, distance of the wound from the brain, type of the wound
(abrasion, small wound, and extensive tissue damage) and dose of virus deposited in the wound
 The incubation therefore ranges from 2 weeks to 1 year with an average of 2-3 weeks.
 Severe pain in the wound
 Extreme anxiety, violent behavior, seizures and hallucinations (Frantic rabies)
 Depression, paralysis of limbs and spasms of pharyngeal muscles (Paralytic rabies)
 Intense hydrophobia (fear of water)

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 Severe pain experienced when swallowing water
 Death usually follows within 10 days
STEP 6: Management of a Patient with Rabies (35 Minutes)

There is no treatment available once a patient develops the symptoms of rabies
 First aid and treatment of the client
o All bite wounds and scratches should be attended to as soon as possible after the exposure
o Wash and flush the wounds immediately with soap and water for 1015 minutes. If soap is not available,
flush with water alone
o Clean the wounds thoroughly with 70% alcohol/ethanol or povidone-iodine, if available.
o Do not stitch the wound
o Infiltrate rabies immunoglobulin (RIG) at the wound.
 If, however, there is a high likelihood that there are additional small wounds, injection of the remaining
half of RIG volume intramuscularly as close as possible to the presumed exposure site, to the degree
that is anatomically feasible, is indicated
 RIG is administered only once, preferably at or as soon as possible after initiation of post-exposure
vaccination. It is not indicated beyond the seventh day after the first dose of rabies vaccine
 The maximum dose of human RIG is 20 IU/kg of body weight, while that of equine immunoglobulin and
F(ab)2 products is 40 IU/kg of body weight
 In the case of mucosal exposure with no wound, rinsing with RIG is recommended.
 In the case of suspected exposure to RABV in an aerosols, an intramuscular injection of RIG is
recommended
o Wounds that require suturing should be sutured loosely and only after RIG infiltration into the wound
o A series of rabies vaccine injections should be administered promptly after an exposure
 The first dose should be administered at day 0
o According to WHO, there are no contraindications to RIG or anti rabies vaccine. They can be safely
administered to infants, pregnant women and immunocompromised individuals, including children with
HIV/AIDS.
o Give tetanus toxoid vaccine where neccessary
 Nursing management of a patient with rabies

o Admit the patient in a quiet room with subdued light and protect them from stimuli (e.g. loud noises, cold air)
that are likely to increase spasms and convulsions.
o Precautions should be taken by the caregiver to avoid bites and saliva contamination of mucous
membranes and wounds by using personal protection equipment.
o Ensure adequate ventilation
o Nurse the patient in a semi-prone position or lateral position
o Sedation with diazepam 10 mg every 46 hours, supplemented by chlorpromazine 50100 mg, or
intravenous morphine if necessary, will help to control muscular spasms and excitability.
o Have a resuscitation tray at hand including oxygen
o Maintain clear airway
o The rest of care is as for a seriously ill patient

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STEP 5: Complications of rabies (05 Minutes)
 Hypothermia
 Pain or difficulty swallowing
 Myocarditis
 Adult respiratory distress syndrome
STEP 6: Prevention and Control of Rabies (05 Minutes)

Rabies is a notifiable disease
 Control of rabies is the responsibility of both the veterinary and human health department
 Health workers have to play part in health education on:
o Regular immunization of dogs and cats
o Reporting of stray dogs to veterinary officers
o Importance of early reporting to the health facility in case of dog or wild animal bite
o Proper storage of the vaccine to maintain its potency
o Eradication of stray dogs
o Eradication of bats in the house
STEP 7: Mode of Transmission of Tetanus (05 Minutes)

 Tetanus is transmitted through the following ways:
o The organism can only live and multiply in the absence of oxygen (anaerobe organisms)
o Normally the tetanus organism live in the intestine of animals and humans
o The organisms are passed out in the faeces of a cow
o In the soil the organisms form spores in order to survive
o The spores enter the body of a human being through wound contaminated with soil, dust and faeces
containing Clostridium tetani OR
o Through skin puncture or cut with an object contaminated with the bacteria Clostridium tetani
o Wounds which favour tetanus include:
 Umbilical stump in new born
 Crush wounds
 Stab (deep) wounds
 Wounds with foreign bodies
 Animal bites
 Burns
 Contaminated surgical wounds
 Chronic ulcers like jiggers, guinea worm etc
STEP 8: Clinical Features of a Patient with Tetanus (10 Minutes)

 The incubation period is 5 21 days (but it can range from 3 days 3 months)
 The disease starts with increased tone in the jaw muscles
 Tonic contraction of jaw muscles (trismus)

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 Risus sardonicus
 Generalized painful spasms of all muscles
 Painful and difficult in swallowing and respiration
 Spasm of neck muscles and neck stiffness
 Asphyxia due to spasms, muscle stiffness and periods of apnoea
 The neck is thrown backwards
STEP 9: Management of a Patient with Tetanus (15 Minutes)

 The patient is referred to hospital as soon as possible after controlling spasms
 Give Diazepam 10 40mg I.V. before referring the patient
 Continue with 10 40mg tablets (crushed) through a gastric tube 3 hourly
 Dose for diazepam is given according to the condition of the patient
 Increase sedatives as the spasms increase
 Reduce dose as the spasms diminish
 Give IV fluids to prevent dehydration and maintain electrolyte balance
 Other drugs to control spasms
o Phenobarbitone 100mg 4 hourly
o Chlorpromazine
 Prevention of secondary infection
o Give crystalline penicillin 1 mega unit stat. followed by PPF 1.2 M.U daily for 5 days
 Provision of Anti tetanus serum
o This is given as prescribed
 Dose 10,000 units I.M. The dose is given after a test dose
 Surgical treatment
o Look for any wound, clean and dress as required
 Nursing care of a patient with tetanus
o Control spasms
o Maintain clear airways
o Provide care as for other seriously ill patient
STEP 10: Complications of Tetanus (05 Minutes)
ACTIVITY: Brainstorming (02 minutes)

ASK students to brainstorm on complications of tetanus
responses
CLARIFY and summarize their responses using the content below
 Paralysis of muscles
 Mental retardation
STEP 11: Prevention and Control of Tetanus (05 Minutes)

 Proper surgical treatment of wounds like removing foreign bodies and dressing

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 All child bearing mothers should be given TT Vaccine for the specific intervals for 5 days to prevent the woman
as well as neonatal tetanus.
 Give DTP HEP- B Hib Vaccine to all under fives
 Cut and punctured wound should be cleaned and dressed
 Avoid wound contamination with soil or animal excreta
 Surgical procedures should be done under strict aseptic technique
 Educate the community on how the disease is spread, dangers and prevention
STEP 12: Key Points (05 Minutes)

 Tetanus is an acute disease caused by a toxin produced by spores of tetanus bacilli
 Tetanus iis characterized by painful contractions of voluntary muscles
 Rabies is a viral disease of animal transmitted to human through a bite of a rabid domestic or wild animal such
as dogs, hyenas, bats
 Immediate management of Rabies (post exposure prophylaxis) includes
o wound cleaning with plenty amount of water and soap for 15 minutes, then thoroughly with 70%
alcohol/ethanol or povidone-iodine
o Administration of Rabies Immunoglobulin, Anti- rabies vaccine and when applicable tetanus toxoid
STEP 13: Session Evaluation (05 Minutes)

 What is rabies?
 What are the preventive and control measures of rabies?
 What are the preventive and control measures of tetanus?
References
Brunner & Suddarths, Smeltser S, and Bare B. et al (2000). Text book of Medical- Surgical Nursing.9th ed.
Philadelphia New York Baltimore: Lippincott, Wliams and Wilkins
Jackson, A.C. et al., 2003. Management of Rabies in Humans. Clinical Infectious Diseases, 36(1), pp.912
MOH, 2017. The United Republic of Tanzania Standard Treatment Guidelines and National Essential
Medicines List 5th ed., Dar es Salaam.
WHO, 2018. WHO Expert Consultation on Rabies, Third Report (Technical Report Series No. 1012), Geneva.

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SESSION 09: CARE OF A PATIENT WITH ANTHRAX AND BRUCELLOSIS USING
NURSING PROCESS
Prerequisite: None
Learning Tasks
Define anthrax and brucellosis
Explain modes of transmission of anthrax
Outline the clinical features of a patient with anthrax
Manage patients with anthrax
Explain preventive measures of anthrax
Outline complications of anthrax
Explain modes of transmission of brucellosis
Outline the clinical features of a patient with brucellosis
Manage patients with brucellosis
Explain preventive measures of brucellosis
Outline complications of brucellosis
Resources Needed

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Session Overview
1. 05 Presentation Session Title and Learning Tasks

2. 05 Buzzing/Presentation Definition of anthrax and brucellosis
3. 10 Lecture/Discussion Mode of Transmission of anthrax
4. 20 Lecture/Discussion Clinical features of a patient with anthrax
5. 05 Lecture/Discussion Management of patients with anthrax
6. 10 Lecture/Discussion Preventive measures of anthrax
7 05 Buzzing/Presentation Complications of anthrax
8. 10 Lecture/Discussion Mode of Transmission of brucellosis
9. 10 Lecture/Discussion Clinical features of a patient with brucellosis
10. 10 Lecture/Discussion Management of patients with brucellosis
11. 10 Lecture/Discussion Preventive measures of brucellosis
12. 10 Lecture/Discussion Complications of brucellosis
13. 05 Presentation Key Points
14. 05 Presentation Session evaluation
SESSION CONTENTS
STEP 2: Definition of Anthrax and Brucellosis (05 Minutes)

ASK students to pair up and buzz on definitions of anthrax and brucellosis
ALLOW 2 to 3 students to provide responses and let others provide additional responses
 Anthrax is an acute bacterial disease caused by spore forming Bacillus anthracis in which humans are infected
by animals
o It occurs most frequently in herbivores such as cattles, goats, and sheeps in parasitic form
 Brucellosis is a bacterial disease caused by a bacterium Brucella by ingestion of unpasteurized milk or

undercooked meat from infected animals, or close contact with their secretions
STEP 3: Modes of Transmission of Anthrax (10 Minutes)

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People acquire anthrax through the following ways (Figure ):
 Cutaneous anthrax: through handling contaminated animal products, spores get in contact with a
cut or scrape on skin-the most common type
 Inhalation anthrax: when a person inhales spores that are in the air (aerosolized) during the
industrial processing of contaminated materials, such as wool, hides, or hair.
 Gastrointestinal anthrax: Eating raw or undercooked meat from infected animals
Source: WHO, 2008
Figure.... Cycle of infection in anthrax
People at risk of getting anthranx

o People working with infected animals or animal products such as wool, hides, or hair.
STEP 4: Clinical Features of a Patient with Anthrax (20 Minutes)

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Depending on the route of exposure to B anthracis spores, patients may present with cutaneous, respiratory, or
gastrointestinal complaints
 Cutaneous anthrax
o Cutaneous anthrax develops 2-5 days (range, 1-7 days) postexposure.
o Lesions most commonly develop at lacerations, abrasions, or insect bites on exposed areas of skin; most
commonly affects upper extremities but may arise anywhere on the body.
o Infection begins as a pruritic papule that enlarges within 24-48 hours to form a 1-cm vesicle; this then
becomes an ulcer surrounded by an edematous halo.
o Lesions may become edematous and necrotic but are usually not purulent.
 They are painless but on occasion are slightly pruritic.
 Regional lymphadenopathy may occur and may be painful.
 The ulcer and edema evolve into a black eschar within 7-10 days and then last for 7-14 days before
separating and leaving a scar.
 Lymphadenopathy may be persistent.
 With neck lesions, edema and lymphadenopathy may impinge on the airway and cause stridor and
respiratory compromise.
 Inhalational anthrax
o Inhalational anthrax begins abruptly 1-3 days (range, hours to 60 days) postexposure
o Typically begins as fever with nonproductive cough and may feature myalgia, fatigue, or retrosternal chest
pain
o Transient clinical improvement may occur after the first few days, followed by rapid progression and clinical
deterioration including the following:
 High-grade fever
 Symptoms of respiratory failure: severe dyspnea, tachypnea, hypoxemia
 Hematemesis or hemoptysis
 Chest pain, which may be severe enough to mimic acute coronary syndrome
 Decreased level of consciousness, meningismus, and coma (with meningeal involvement)
 Intestinal anthrax
o Intestinal anthrax develops 2-5 days after ingestion.
o Commonly presents as nonspecific abdominal pain with fever; may be associated with nausea, vomiting,
malaise, anorexia, hematemesis, dysentery, and/or diarrhea
o Distributive or hypovolemic shock may develop depending on the severity of illness.
STEP 5: Management of Patients with Anthrax (05 Minutes)

o Immediately notify the National Surveillance System as soon as there is a suspect case of anthrax detected.
o Treat cases on site, in an isolation ward or an established isolation centre
o Use Personal Protective Equipment (PPE) before attending a suspected patient
o Wash hands with liquid soap and running water or use sanitizers as protective measures
o Benzylpenicillin. Adult 0.6 MU I.V every 6 hours until local oedema subsides then continue with
o Phenoxymethylpenicillin 250 mg 6 hourly for 7 days
o Paracetamol 15mg/kg 8 hourly for 3 days
STEP 6: Preventive Measures for Anthrax (10 Minutes)

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o Intersectoral cooperation is important for the effective prevention and control of anthrax
o If a potential infectious animal source is known to exist, this should be eliminated without delay.
o In the event of a case or outbreak occurring in livestock, control measures consist of:
o Correct disposal of the carcass (es)
o Decontamination of the site(s) and of items used to test and dispose of the carcass (es)
o Iinitiation of treatment and/or vaccination of other animals as appropriate.
o Provision of health education to the general public and to those who handle livestock, meat, hides and other
animal products
o Wearing of personal protective equipment (PPE) when handling animal carcases, meat, hides or other
animal products
o Antibiotic prophylaxis - Where sufficient fear of a substantial exposure in a natural situation exists (e.g.
consumption of meat from a poorly cooked anthrax carcass)
o Effective surveillance (disease detection, reporting, confirmation of diagnosis, collation of data and feedback
of the data to the source)
STEP 7: Complications of Anthrax (05 Minutes)

ASK students to pair up and buzz on complications of anthrax
 The most serious complication of anthrax is inflammation of the membranes and fluid covering the brain and
spinal cord, leading to massive bleeding (hemorrhagic meningitis) and death
STEP 8: Modes of Transmission of Brucellosis (10 Minutes)

People can get the disease when they are in contact with infected animals or animal products contaminated with the
bacteria. Animals that are most commonly infected include sheep, cattle, goats, pigs, and dogs, among others
(figure.....)
 Eating undercooked meat or consuming unpasteurized/raw dairy products the most common way
 Breathing in the bacteria that cause brucellosis (inhalation): the risk is greater for people in
laboratories that work with the bacteria, slaughterhouse and meat-packing employees
 Bacteria enter the body through skin wounds or mucous membranes

o Bacteria can also enter wounds in the skin/mucous membranes through contact with
infected animals. This poses a problem for workers who have close contact with animals or
animal excretions:
 slaughterhouse workers
 meat-packing plant employees
 veterinarians

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 pastoralists
 hunters
 Person-to-person spread of brucellosis is extremely rare
 Infected mothers who are breast-feeding may transmit the infection to their infants.
 Sexual transmission has been rarely reported.
 While uncommon, transmission may also occur via tissue transplantation or blood transfusions.
Figure..Transmission of brucellosis to a human being
STEP 9: Clinical Features of a Patient with Brucellosis (10 Minutes)
Brucellosis can cause of range of signs and symptoms, some of which may present for prolonged periods
of time.
 Initial symptoms can include:
o fever
o sweats
o malaise
o anorexia
o headache
o pain in muscles, joint, and/or back
o fatigue
 Some signs and symptoms may persist for longer periods of time. Others may never go away or
reoccur
 These can include:
 recurrent fevers

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 arthritis
 swelling of the testicle and scrotum area
 swelling of the heart (endocarditis)
 neurologic symptoms (in up to 5% of all cases)
 chronic fatigue
 depression
 swelling of the liver and/or spleen
STEP 10: Management of Patients with Brucellosis (10 Minutes)
The goal of medical therapy in brucellosis is to control symptoms as quickly as possible in order to prevent
complications and relapses.
o Initial care for brucellosis is supportive.
o Wear PPE such (e.g., mask, gloves, and eye protection) for respiratory procedures or handling body
fluids
o For simple infections

 Doxycycline (100 mg PO twice daily for 6 weeks) and rifampin (600-900 mg/day)
 Fluoroquinolones (eg, ciprofloxacin)
o For acute brucellosis in adults and children older than 8 years, the World Health Organization (WHO)
guidelines recommend the following:
 Doxycycline 100 mg PO twice daily plus rifampin 600-900 mg/day PO Both drugs are to be given
for 6 weeks; this regimen is more convenient but probably increases the risk of relapse
 Doxycycline 100 mg PO twice daily for 6 weeks and streptomycin 1 g/day IM for 2-3 weeks This
regimen is believed to be more effective, mainly in preventing relapse; gentamicin can be used as
a substitute for streptomycin and has shown equal efficacy
 Ciprofloxacin-based regimens have shown efficacy equal to that of doxycycline-based regimens
STEP 11: Preventive Measures for Brucellosis (10 Minutes)

 Prevention of brucellosis in humans depends on eradication or control of the disease in animals and on avoiding
potential sources of infection.
o Better handling of infected animals or animal products is paramount
o Public awareness and education play major roles in prevention
o Consumption of unpasteurized milk and milk products, as well as of raw or undercooked meats,
should be avoided.
o Scrupulous hygiene, especially for individuals likely to have close contact with goats, sheep, cows,
camels, pigs, reindeer, rabbits, or hares.

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o All persons with an occupational risk for brucellosis should be informed about the use of protective
devices (eg, goggles, masks, and gloves) to avoid exposure to aerosols, body fluids, or the
brucellosis vaccine.
.
STEP 12: Complications of Brucellosis (10 Minutes)

 Complications are rare in the patient who is treated appropriately. The most common focal complications fall into
the following categories:
o Osteoarticular :Spondylitis, arthritis, osteomyelitis, bursitis, and tenosynovitis have been reported.
o Peripheral joint involvement usually includes the knees, hips, ankles, and shoulders and can be
monoarticular or polyarticular
o Hepatobiliary: hepatitis, hepatic abscess, and acute cholecystitis. Gastrointestinal: ileitis, colitis,
and spontaneous peritonitis
o Genitourinary: orchitis or epididymo-orchitis
o Renal involvement is rare, although glomerulonephritis and pyelonephritis have been reported.
o Infection in pregnant patients is rare and is associated with first-trimester abortions.
Neurobrucellosis: occurs more frequently in endemic regions and develops in approximately 5% of
cases.
o Meningitis and, less commonly, papilledema, optic neuropathy, radiculopathy, stroke, and
intracranial hemorrhage may be seen.
o Acute meningoencephalitis
o Cardiovascular: endocarditis

 Anthrax is a spore-forming bacterial disease spread from animal to humans
 The disease is manifested in the skin, lungs and bowels
 The most serious type of anthrax is anthrax of the lungs
 The drug of choice for treatment of anthrax is penicillin
 Brucellosis is transmitted to humans through:
o Close contact with infected animal
o Contact with tissue, blood, urine, vaginal discharge, aborted foetus or placenta of infected animal
o Ingestion of milk or product of infected animal

 What is the mode of transmission of anthrax?
 How can anthrax be prevented?
 How can brucellosis be prevented?
References

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Allender J, Spradley B. (2001). Community Health Nursing: Concepts and practice 5th ed. Philadelphia
NewYork Baltimore: Lippincott
Basavanthappa B., (2004). Fundamentals of nursing first edition. New Delhi: Medical Publishers (P)
New Delhi
Gupte, S. (2010).The Short Textbook of Medical Microbiology (Including Parasitology), 10th ed. New Delhi.
Jaypee Brothers Medical Publishers (P) Ltd
Heymann D.(2008). Control of communicable diseases manual,19thed. Washington DC: WHO
Nordberg E. et al, (2007). Communicable diseases: A manual for health workers in sub-Saharan Africa
AMREF, Nairobi
SESSION 11: STIGMA AND DISCRIMINATION IN MANAGING HIV

AND AIDS AND KEY POPULATION CLIENTS

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Prerequisite:None
Learning Tasks
At the end of this session the learner is expected to be able to:
Define stigma, discrimination and key population

Differentiate between stigma and discrimination
Outline the impact of stigma and discrimination in managing HIV and AIDS and key
population clients
Identify gender norms that influence stigma and discrimination towards HIV and
AIDS and key population (KP) clients
Explain effect of stigma in provision of health care to key population and HIV and
AIDS clients
Resources Needed:
Session Overview Box

Method
1. 05 Presentation Session Title and Learning Objectives
2. 05 Buzzing Definition of stigma, discrimination and key population
Lecture/ Discussion
3. 05 Lecture/ Discussion Difference between stigma and discrimination
4 25 Brainstorming Impact of stigma and discrimination in managing HIV
Lecture/ Discussion and AIDS and key population clients
5 40 Lecture/ Discussion Gender norms that influence stigma and discrimination

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towards HIV and AIDS and key population (KP) clients
6. 30 Small group discussion Effect of stigma in provision of health care to key
Lecture/ Discussion population and HIV and AIDS clients

SESSION CONTENTS
STEP 2: Definition of Stigma, Discrimination and Key Population (05 Minutes)

ASK students to pair up and buzz on the definitions of stigma, discrimination and key population
 Stigma involves a complex process in society of negatively labeling people who are different and this has
negative consequences at all levels of society
o Stigma involves seeing people as different and relating to them negatively.
 Discrimination means treating a person unfairly because of who they are or because they possess certain
characteristics.
o Discrimination is the action or consequences as a result of being stigmatized
 Key Population/groups refers to groups of people who are both more vulnerable to and affected by HIV such as
men who have sex with men and injecting drug users, often avoid or delay seeking needed services for stigma-
related reasons
STEP 3: Differences between Stigma and Discrimination(05 Minutes)

Stigma Discrimination
 Is negative stereotype  Is behaviour that results from this negative
stereotype
 Can be concealed  Always overt
 Reflects attitude  Reflects behaviour

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STEP 4: The Impact of Stigma and Discrimination in Managing HIV and AIDS and Key
Population Clients (25 Minutes)
ASK students to brainstorm on the impact of stigma and discrimination in managing HIV and AIDS and
key population clients for 5 minutes
 HIV-related stigmatisation and discrimination threaten the effectiveness of HIV prevention and care programs.
o They create a climate that negatively impacts on effective prevention by discouraging individuals especially
key population from coming forward for testing, and from seeking information on how to protect themselves
and others, thus deepening the adverse impact of living with HIV and AIDS
o People at risk of HIV infection or already infected may choose not to access health care, prevention and
education services for fear of being stigmatised by health care and service providers.
o HIV related stigma and discrimination affects many of the choices that People Living with HIV and AIDS
(PLWHA), or people at risk, make about being tested and seeking assistance for their physical,
psychological and social needs
o People living with HIV and AIDS who hide their HIV status can be affected by depression, stress and social
isolation.
o The need for secrecy about HIV status can also affect whether or not people are receiving life saving
treatment, and adhering successfully to that treatment
o Key population, such as men who have sex with men and injecting drug users, often avoid or delay seeking
needed services for stigma-related reasons.
STEP 5: Gender Norms that Influence Stigma and Discrimination towards HIV and
AIDS and Key Population (KP) Clients (40 Minutes)
The influence of gender norms on stigma and discrimination is particularly a reality that cuts across all facets of life.
For many women and girls, the gender dimensions of HIV-related stigma and discrimination remain a reality. The
influence of gender norms on stigma and discrimination could partly be explained by the following aspects:
 HIV-related stigma can influence a womans decisions about her reproductive choices and prevention of
mother-to-child transmission (PMTCT)
o Fear of revealing their HIV status and experiencing the consequences (for example, abandonment by
partners and family).
o A woman using formula feed for an infant, risks isolation within societies where breastfeeding is the
norm.
o Women living with HIV may face stigmatizing attitudes and inappropriate actions by both staff and other
clients, for example that they do not have the right to enjoy sexual relations or have children
 Stigma can particularly affect a womans use of life-saving ART clinical attendance and adherence to
medication regimen.

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o Fear of being seen at an HIV centre or lacking private places at home to store the drugs.
 Access to services and the influence of stigma can be especially challenging for women living with HIV
who are from key populations.
o Accessing ART may require a female sex worker to reveal both her HIV status and her work risking
multiple layers of stigma.
 HIV-related stigma in social settings can impact on a womans and girls ability to:
o participate in family and community life
o maintain her mental health
o adhere to medication
o maintain her reproductive health
o safely feed infants and
o enjoy her sexuality and rights
 Women whose daily lives often centre on the household and community may be more likely to be seen
accessing HIV services or to face social pressure to be open about health issues with their family, including
in-laws.
 Stigma can be particularly intense even overwhelming for women living with HIV from particular types of
communities, such as those in rural areas, of ethnic minorities or that are strongly conservative or religious.
 Within intimate relationships, HIV-related stigma can be influenced by gender patterns. Women are often
the first to know their status, for example if they are tested when going for antenatal screening, and can then
be blamed for bringing ill health into a relationship.
o This can be particularly so when the other partners status is unknown or undisclosed, and processes of
denial associated with coming to terms with an HIV-positive diagnosis can also lead to accusations of
infidelity.
 They may also find it particularly difficult to negotiate sexual relations with gender stereotypes making it
unacceptable for women to speak openly about safer sex and condom use
 Women may particularly fear the repercussions of HIV-related stigma by their partners, such as physical
violence and verbal abuse

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STEP 6: Effect of Stigma in Provision of Health Care to Key Population and HIV and
AIDS Clients (30 Minutes)
Activity: Small Group Discussion (15 Minutes)

DIVIDE student into small manageable groups (3-6 groups)
ASK students in a large group: What are the effects of attitude and stigma on health care
provision to key population and HIV and AIDS clients?
ALLOW time to discuss the responses, and write their responses on a flip chart
ASK students to present their work in the formed groups
CLARIFY and summaries by using the information below
 Lower Uptake of Preventive Services and Testing

o Stigma and discrimination are associated with lower uptake of preventive services, including:
 Under- or non-participation in educational meetings and counselling
 Lower intention to take preventive measures
 Reduced participation in programmes to prevent mother-to-child transmission
 Facing obstacles to HIV prevention services among key population as subjects to human rights
violation
o Stigmatising attitudes are associated with denial of, risk and a lower likelihood of adopting preventive
behaviours
 Reduced and Delayed Disclosure: Disclosure of serostatus is a key for outcomes ranging from condom use to
care seeking.
o Stigma and discrimination adversely affect disclosure to partners, providers and family members
 Postponement or Rejection of Treatment, Care and Support

o Due to stigmatization and breach of confidentiality by health workers, people living with HIV and AIDS may
decide to quit the service or seeking care far away to another health facility
o Key groups, such as men who have sex with men and injecting drug users, often avoid or delay seeking
needed services for stigma-related reasons. These include fear of being found out; discrimination by health
workers; and, in some instances, imprisonment and/or having their property taken away

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 Stigma and discrimination are the major obstacles towards HIV and AIDS prevention
 HIV related stigma and discrimination affects many of the choices that People Living with HIV and AIDS
(PLWHA), or people at risk, make about being tested and seeking assistance for their physical, psychological
and social needs

 In what ways can Attitude and Stigma to Key Population and HIV and AIDS Clients affect health acre provision?
References
DFID, 2007. Taking Action Against HIV Stigma and Discrimination: Guidance Document and Supporting Resources,
IPPF, 2011. Piecing it Together for Women and Girls: The Gender Dimentions of HIV-related Stigma,
MOH, 2007. National Guidelines for Management of Sexually Transmitted and Reproductive Tract Infections First.,
Dar.
WHO, 2014. Consolidated HIV Prevention, Diagnosis, Treatment and Care for Key populations, Geneva: WHO
Press.
SESSION 11: CARE OF PATIENTS WITH HIV AND AIDS ACCORDING TO

WHO STAGES
Prerequisite: None
Learning Tasks
Identify classification of HIV and AIDS staging according to WHO
Outline signs and symptoms in each of WHO Clinical stage
Resources Needed:
Manage patients with HIV and AIDS

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Method
2. 15 Buzzing Classification of HIV and AIDS staging according to
Lecture/ Discussion WHO
3. 60 Small group discussion Signs and symptoms in each of WHO Clinical stage
Lecture/ Discussion
4. 30 Lecture/ Discussion Management of patients with HIV and AIDS
SESSION CONTENTS
STEP 2: Classification of HIV and AIDS Staging According to WHO (15 Minutes)

ASK students to pair up and buzz on classification of HIV and AIDS staging according to WHO
 WHO has developed a clinical and laboratory classification system for predicting morbidity and mortality of
infected adults based on both clinical symptoms and lab markers and it incorporates a patient performance
scale.
 According to World Health Organization (WHO), the HIV and AIDS clinical staging is divided into two main
groups:
o Clinical staging for Adolescents and Adults
o Clinical staging for Children

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 There are four WHO HIV and AIDS clinical stages for both Adult and Adolescents; and Children. These include:
o Clinical Stage 1
 Asymptomatic: May last for an average of eight to ten years
 Persistent generalized lymphadenopathy
o Clinical Stage 2 and Stage 3

 Over time the immune system loses the struggle to contain HIV, and symptoms develop. Symptomatic
HIV infection is often caused by the emergence of OIs.
o Clinical Stage 4
 Diagnosis of AIDS is confirmed if a person with HIV develops one or more of a specific number of
severe opportunistic infections (OIs) or cancers.
STEP 3: Signs and Symptoms in Each of WHO Clinical Stage (60 Minutes)
Activity: Small Group Discussion (30 Minutes)

DIVIDE student into small manageable groups (3-6 groups)
ASK students in a large group: What are the specific signs and symptoms in each clinical
WHO stage for both Adult and Adolescents; and Children?
ALLOW time to discuss the responses, and write their responses on a flip chart
ASK students to present their work in the formed groups
CLARIFY and summaries by using the information below
Adults and Adolescents
 Stage 1
o Usually asymptomatic and may go on for many years
o However, swollen lymph nodes (persistent generalized lymphadenopathy) are commonly seen as this is
where more and more soldiers (immune cells) are produced in an attempt to fight against the HIV
o Performance Scale 1: Asymptomatic, normal activity
 Maintaining a healthy lifestyle is important for maintaining good health for as long as possible
 Stage 2
o Moderate unexplained weight loss (<10% of presumed or measured body weight)
o Recurrent respiratory tract infections: sinusitis, tonsillitis, otitis media and pharyngitis)
o Herpes zoster
o Angular cheilitis
o Recurrent oral ulceration (two or more episodes in last 6 months)
o Papular pruritic eruptions
o Seborrhoeic dermatitis
o Fungal nail infections

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o Minor mucocutaneous manifestations
o CD4 count falls below 350, indicating that the immune system is weakening in turn infections are seen more
often than usual.
o Performance Scale 2 for stage 2: Symptomatic, normal activity
 Medication may help the patient to fight these infections and it is possible to continue with daily life
 Maintaining health is essential.
 Clinical Stage 3
o Severe Unexplained severe weight loss (>10% of presumed or measured body weight)
o Unexplained chronic diarrhoea for longer than one month
o Unexplained persistent fever (above 37.6°C intermittent or constant, for longer than one month)
o Persistent oral candidiasis
o Oral hairy leukoplakia
o Pulmonary tuberculosis (current)
o Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis
or bacteraemia)
o Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
o Unexplained anaemia (<8 g/dl), neutropaenia (<0.5 × 109 per litre) or chronic thrombocytopaenia (<50×109
per litre)
o Performance Scale 3 for stage 3: Bedridden, < 50% of the day during the last month
 As CD4 count drops further, more serious, debilitating Opportunistic Infections occur.
 Weight loss continues, along with a lack of energy and reduced ability to carry out daily activities
 Stage 4
o HIV wasting syndrome
o Pneumocystis pneumonia
o Recurrent bacterial pneumonia (this episode plus one or more episodes in last 6 months)
o Chronic herpes simplex infection (orolabial, genital or anorectal of more than one months duration or
visceral at any site and at any duration)
o Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
o Extrapulmonary tuberculosis
o Kaposis sarcoma
o Cytomegalovirus infection (retinitis or infection of other organs excluding liver, spleen and lymph nodes)
o Toxoplasmosis of the central nervous system
o HIV encephalopathy
o Extrapulmonary cryptococcosis including meningitis
o Disseminated non-tuberculous mycobacterial infection
o Progressive multifocal leukoencephalopathy
o Cryptosporidiosis (with diarrhoea lasting more than 1 month)
o Chronic isosporiasis
o Disseminated mycosis (coccidiomycosis or histoplasmosis)
o Recurrent septicemia (including non-typhoidal Salmonella )
o Lymphoma (cerebral or B-cell non-Hodgkin) or other solid HIV-associated tumours
o Weight loss is considerable
o Performance Scale 4 for stage 4: Bedridden, >50% of the day during the last month
o CD4 count may reach 0
Children

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o Asymptomatic
o Persistent generalized lymphadenopathy
o Unexplained persistent hepatosplenomegaly
o Papular pruritic eruptions
o Lineal gingival erythema
o Extensive wart virus infection
o Extensive molluscum contagiosum
o Recurrent oral ulcerations
o Unexplained persistent parotid enlargement
o Herpes zoster
o Recurrent or chronic upper respiratory tract infections (otitis media, otorrhoea, sinusitis or tonsillitis)
o Fungal nail infection
o Unexplained moderate malnutrition or wasting not adequately responding to standard therapy
o Unexplained persistent diarrhoea (14 days or more)
o Unexplained persistent fever (above 37.5°C intermittent or constant, for longer than one month)
o Persistent oral candidiasis (after first 6 weeks of life)
o Oral hairy leukoplakia
o Acute necrotizing ulcerative gingivitis or periodontitis
o Lymph node tuberculosis
o Pulmonary tuberculosis
o Severe recurrent bacterial pneumonia
o Symptomatic lymphoid interstitial pneumonitis
o Chronic HIV-associated lung disease including brochiectasis
o Unexplained anaemia (<8 g/dl), neutropaenia (<0.5 × 109 per litre) and or chronic thrombocytopaenia (<50
× 109 per litre)
o Unexplained severe wasting, stunting or severe malnutrition not responding to standard therapy
o Pneumocystis pneumonia
o Recurrent severe bacterial infections (such as empyema, pyomyositis, bone or joint infection or meningitis
but excluding pneumonia)
o Chronic herpes simplex infection (orolabial or cutaneous of more than one months duration or visceral at
any site)
o Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
o Extrapulmonary tuberculosis
o Kaposi sarcoma
o Cytomegalovirus infection: retinitis or cytomegalovirus infection affecting another organ, with onset at age
older than one month
o Central nervous system toxoplasmosis (after one month of life)
o Extrapulmonary cryptococcosis (including meningitis)
o HIV encephalopathy
o Disseminated endemic mycosis (coccidioidomycosis,penicilliosis or extra pulmonary histoplasmosis)
o Disseminated non-tuberculous mycobacterial infection
o Chronic cryptosporidiosis (with diarrhoea)

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o Chronic isosporiasis
o Cerebral or B-cell non-Hodgkin lymphoma
o Progressive multifocal leukoencephalopathy
o HIV-associated nephropathy or cardiomyopathy
STEP 4: Management of Patients with HIV and AIDS (30 Minutes)

The goals of nursing care related to patients living with HIV and AIDS include reducing morbidity and mortality and
increasing the quality of life of people affected by HIV and those at risk for the disease. The interventions involve the
following:
 Teach health promotion

o Promoting healthy practices (also called positive living) that prolong the asymptomatic stage
 Provision of prophylaxis against opportunistic infections (OIs)
 Encourage patients to engage in positive health behaviors such as:
o adherence to clinical appointments
o adherence to current medication schedule (e.g., prophylactic medications)
o proper nutrition
o ongoing prevention to reduce the risk of transmission or re-infection of HIV and other disease f
 Management of ART as well as other essential elements of care and support
 Monitor medication use and provide patient education for all medications, whether ARVs, prophylaxis,
antibiotics, narcotics, etc.
o dose schedule
o adherence
o food restrictions
o possible side effects
 Provision of prophylaxis for OIs and, if an OI occurs, aggressive treatment of the infection.
 Provision of palliative care (management of distressing symptoms such as thrush)
 At the end of life, provide care and support to enable the patient to live life as fully and comfortably as
possible.
 Identify needs (along with the patient and family) and refer to appropriate services within the clinical or
community setting
 Practice standard precautions at work
 Know the post exposure prophylaxis (PEP) protocol of the health facility. Encourage implementation of
PEP if needed

 WHO staging system for HIV has 4 stages and is used as a HIV/AIDS classification system
 Most Stage I persons are asymptomatic
 The goals of managing patients with HIV and AIDS include reducing morbidity and mortality and increasing the
quality of life of people affected by HIV and those at risk for the disease

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 What are the signs and symptoms of a patient in WHO clinical stage two?
References
MOH, 2010. Management of Common Symptoms and Opportunistic Infections in HIV and
AIDS. National Guidelines for the Clinical Management of HIV/AIDS. MOH, Dar es Salaam.
SESSION 11: CONCEPTS OF HELMINTHIC INFESTATIONS
Prerequisite: None
Learning Tasks
Define helminthic infections
List common helminthic infections
Classify common helminthics causing diseases to human being

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Resources Needed:

Method
2. 05 Buzzing Definition of helminthic infections
3. 05 Lecture/ Discussion Common helminthic infestations
4. 30 Lecture/ Discussion Classification of common helminthics causing diseases
to human being
SESSION CONTENTS
STEP 2: Definition of Helminthic Infections (05 Minutes)

ASK students to pair up and buzz on definitions of helminthic infections
 Helminthic infections are caused by the worms due to poor sanitation in which children are more frequently
infected.
o Malnutrition makes the health of individual with intestinal parasites worse.

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STEP 3: Common helminthic Infections (05 Minutes)
 Helminthic infestations are grouped into the following categories according to the type of parasite:
o Nematodes or roundworms
o Cestodes or tapeworms
o Trematodes or flukes
STEP 4: Classification of Common Helminths Causing Diseases to Human Being (30

Minutes)
 The definitive classification is based on the external and internal morphology of egg, larval, and adult stages
 The clinically relevant groups are separated according to their general external shape and the host organ they
inhabit. There are both hermaphroditic and bisexual species
Nematodes or roundworms.
 Adult and larval roundworms are bisexual, cylindrical worms. They inhabit intestinal and extraintestinal sites.
o Ascaris Lumbricoides (Round worms)

o Strongloides stecoralis
o Ancylostomiasis (Hookworms)
o Trichuris trichira
o Enterobius vermicularis
o Filarial worms
o Cestodes or tapeworm: Adult tapeworms are elongated, segmented, hermaphroditic flatworms that inhabit
the intestinal lumen. Larval forms, which are cystic or solid, inhabit extraintestinal tissues.
 Taenia Saginata
 Taenia Solium
 Echinococcus Granulosus
o Trematodes or flukes: Adult flukes are leaf-shaped flatworms. Prominent oral and ventral suckers help
maintain position in situ. Flukes are hermaphroditic except for blood flukes, which are bisexual. The life-
cycle includes a snail intermediate host.
 Schistosoma Haematobium
 Schistosoma mansoni

 Helminthic infections are caused by the worms due to poor sanitation in which children are more frequently
infected. Malnutrition makes the health of individual with intestinal parasites worse.
 The clinically relevant groups of helminthes are separated according to their general external shape and the host
organ they inhabit.There are both hermaphroditic and bisexual species
STEP 4: Session Evaluation(10 Minutes)

 What are the common helminthic infestations?
 What are the types of worms in each group of helminth according to shape?

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References
Castro, G.A., 1996. Helminths: Structure, Classification, Growth, and Development. In B. S, ed. Medical
Microbiology. Texas: University of Texas Medical Brach at Galveston.
Cook, G.C. & Zumla, A.I., 2014. Mansons Tropical Diseases Twenty Sec. G. C. Cook & A. I. Zumla, eds.,
Saunders.
Heymann, D. (2008). Control of Communicable Diseases Manual.(19th ed). Washington
DC: WHO
Ngatia, P., Tiberry,P., Oirere,B., et al. (2008). Community Health. (3rd ed). Nairobi: AMREF.
Nordberg, E.(2007). Communicable Diseases. A Manual for Health Workers in Sub-Saharan
Africa. Nairobi: AMREF
Stanhope, M. & Lancaster, J. (2000). Community Public Health Nursing. (5th ed).St.Louis,
London, Philadelphia, Sydney and Toronto: Mosby
SESSION 11: CARE OF PATIENTS WITH TRICHURIASIS AND

ASCARIASIS
Prerequisite:
 None
Learning Tasks
Define trichuriasis and ascariasis
Identify causative agents of trichuriasis and ascariasis
Describe mode of transmission of trichuriasis
Identify the diagnostic measures of trichuriasis
Manage patients with trichuriasis
Describe complications of trichuriasis
Describe mode of transmission of ascariasis
Identify the diagnostic measures of ascariasis
Manage patients
NMT 05211: Management with ascariasis
of Communicable Diseases
Describe complications of ascariasis 119
119
Resources Needed:

Method
2. 05 Buzzing Definition of trichuriasis and ascariasis
Lecture/ Discussion
3. 05 Lecture/ Discussion Causative agents of trichuriasis and ascariasis
4. 20 Lecture/ Discussion Mode of transmission of trichuriasis
5. 10 Lecture/ Discussion Diagnostic measures of trichuriasis
6. 10 Lecture/ Discussion Management of patients with trichuriasis
7. 05 Lecture/ Discussion Describe complications of trichuriasis
Mode of transmission of ascariasis
Diagnostic measures of ascariasis
Management of patients with ascariasis
Complications of ascariasis
SESSION CONTENTS

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STEP 02: Definition of Trichuriasis and Ascariasis (05 Minutes)

ASK students to pair up and buzz on definitions of trichuriasis and ascariasis
 Trichuriasis: is the intestinal disease caused by the parasitic round worm Trichuris trichiura
o Trichuris trichiura is also known as whipworm
 Ascariasis: is the intestinal disease caused by the parasitic roundworm Ascaris lumbricoides
STEP 03: Causative Agents of Trichuriasis and Ascariasis (05 Minutes)

Trichuriasis
 Is caused by Trichuris trichiura Whipworm caused
Ascariasis
 The major cause of ascariasis in human population is roundworm known as Ascaris lumbricoides
 Human can also be infected by pig roundworm (Ascaris suum)
 Ascaris lumbricoides (human roundworm) and Ascaris suum (pig roundworm) are indistinguishable. It is
unknown how many people worldwide are infected with Ascaris suum
STEP 04: Mode of Transmission of Trichuriasis (05 Minutes)

 The mode of transmission is faecal oral route
STEP 05: Diagnostic Measures of Trichuriasis (05 Minutes)
 The diagnosis is made by finding the characteristic eggs in the stool

o T. trichiura eggs have a characteristic barrel shape with two terminal polar plugs
 Kato-Katz method is recommended by WHO
STEP 06: Management of Patients with Trichuriasis (05 Minutes)
 Drug of choice is Mebendazole or Albendazole

o The suggested dose of mebendazole 100 mg twice a day for 3 days or albendazole is 200 to 400
mg twice a day for 3 days.
o Mebendazole has been shown to be more effective and is considered the first-line treatment.

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 Ivermectin (200 mcg/kg daily) can be used; however, it is not as effective as the first mebendazole and
albendazole
STEP 07: Complications of Trichuriasis (05 Minutes)
 Trichuris dysentery syndrome can be found in children and is seen when there is a very high worm burden.
o This often leads to diarrhea, tenesmus, iron deficiency anemia and growth retardation.
o The growth retardation is typically secondary to poor nutrition and consequently causes the cognitive delay
STEP 08: Mode of Transmission of Ascariasis (05 Minutes)

 The mode of transmission is as follows:
o Human are infected by eating food contaminated with mature eggs of Ascaris lumbricoides
o The usual vehicles are fruits and other raw foods
STEP 09: Diagnostic Measures of Ascariasis (10 Minutes)
 In heavy infestations in cough or vomit, and or come out of other body openings, such as mouth or
nostrils
 Stool tests stool examination for the microscopic eggs and larvae
 Blood tests: Full blood Picture may show an increase in eosinophils
 In massive infestations: X-rays can reveal the mass of worms in abdomen. In some cases, a chest X-
ray can reveal the larvae in lungs
 Ultrasound: May show worms in abdomen, pancreas or liver
 CT scans or MRIs: May also be used to detect worms e.g. those blocking ducts in the liver or
pancreas
STEP 10: Management of Patients with Ascariasis (10 Minutes)
Treatment
 Mebendazole 500 mg or
 Albendazole 500 mg
 Levamisole (Ketrax) 3 tablets single dose
 Piperizen 150 mg / kg / bw- Single dose
 Management of complications
o Refer to the hospital for further management
STEP 11: Complications of Ascariasis (05 Minutes)

 Intestinal obstruction
 Blockage of bile duct by worms causing obstructive Jaundice
 Worms may block airways causing difficulty in breathing

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 Malnutrition
 Liver abscess

 Trichuriasis is a disease caused by the parasitic round worm Trichuris trichiura
 Ascariasis is a disease caused by the parasitic roundworm Ascaris lumbricoides
 Ascariasis if untreated can lead to serious complications such as intestinal obstruction and difficulty in breathing

 What are the mode of transmission of ascariasis and trichuriasis?
 What are the preventive measures of ascariasis and trichuriasis?
References
Cook, G.C. & Zumla, A.I., 2014. Mansons Tropical Diseases Twenty Sec. G. C. Cook & A. I. Zumla, eds., Saunders.
DC: WHO
Ngatia, P., Tiberry,P., Oirere,B., et al. (2008). Community Health. (3rd ed). Nairobi: AMREF.
Nordberg, E.(2007). Communicable Diseases. A Manual for Health Workers in Sub-Saharan
Africa. Nairobi: AMREF
Stanhope, M. & Lancaster, J. (2000). Community Public Health Nursing. (5th ed).St.Louis,
London, Philadelphia, Sydney and Toronto: Mosby
SESSION 11: CARE OF A PATIENT WITH STRONGYLOIDIASIS
Prerequisite:
Learning Tasks
 None
Define strongyloidiasis
Explain the epidemiology of strongyloidiasis
Describe mode of transmission of strongyloidiasis
Explain lifeofcycle
NMT 05211: Management of strongloidiasis
Communicable Diseases
Outline the clinical features of patients with strongyloidiasis 123
Identify diagnostic measures of strongyloidiasis
123
Manage patients with strongyloidiasis
Outline complications of strongyloidiasis
Resources Needed:

1. 05 Presentation Session Title and learning tasks

2. 05 Brainstorming/ Definition of strongyloidiasis
Presentation
3. 05 Lecture/ Discussion Epidemiology of strongyloidiasis
4. 05 Lecture/ Discussion Mode of transmission of strongyloidiasis
05 Lecture/ Discussion Life cycle of strongyloidiasis
5. 10 Lecture/ Discussion Clinical features of patients with strongyloidiasis
6. 05 Lecture/ Discussion Diagnostic measures of strongyloidiasis
7. 05 Lecture/ Discussion Management of patients with strongyloidiasis
8. 05 Lecture/ Discussion Complications of strongyloidiasis
SESSION CONTENTS

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STEP 2: Definition of Strongyloidiasis (05 Minutes)

ASK each student to brainstorm on the definition strongyloidiasis
WRITE their responses on the board/flipchart
CLARIFY and summarize by using the content below
 Strongyloidiasis is a parasitic disease caused by a nematode worm, Strongyloides stercoralis
STEP 3: Epidemiology of Strongyloidiasis(05 Minutes)

 Estimates of global prevalence are probably unreliable due to difficulties in diagnosing infection.
 Strongyloidiasis has a worldwide distribution, prevalent in parts of tropical South America, China and South-east
Asia.
 Strongyloidiasis thrives in conditions of overcrowding on damp soil in tropical conditions
 Larvae are unable to survive temperatures below 8°C or above 40°C or desiccation.
 In temperate climates it occurs at low prevalence but is common in inmates of institutions, such as mental
hospitals, prisons and the mentally retarded childrens homes.
 Infection is normally more prevalent among males than females and increases with age
 It has become a serious problem in individuals receiving immunosuppressive treatment.
STEP 4: Mode of Transmission of Strongyloidiasis(05 Minutes)

 Mode of Transmission:
o Primary mode of infection is through contact with soil that is contaminated with free-living larvae.
 When the larvae come in contact with skin, they penetrate it and migrate through the body to
the small intestine where they burrow and lay their eggs.
o Autoinfection by the hatched larvae in the small intestine
 Burrow in the intestinal wall or perianal skin
STEP 5: Life Cycle of Transmission of Strongyloidiasis(05 Minutes)

o The life cycle is complex and involves two stages in which reproduction takes place:
 an internal sexual cycle involving parasitic worms and
 the external sexual cycle involving free-living worms

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o Free-living cycle:
 The rhabditiform larvae passed in the stool can either become infective filariform larvae (direct
development) or free living adult males and females that mate and produce eggs from which
rhabditiform larvae hatch and eventually become infective filariform larvae
 The filariform larvae penetrate the human host skin to initiate the parasitic cycle
o Parasitic cycle:
 Filariform larvae in contaminated soil penetrate the human skin, and
 By various, often random routes, migrate into the small intestine
 In the small intestine they molt twice and become adult female worms
 The females live threaded in the epithelium of the small intestine and by parthenogenesis produce
eggs, which yield rhabditiform larvae.
 The rhabditiform larvae can either be passed in the stool (to initiate thefree-living cycle), or can cause
autoinfection.
Adapted from https://www.cdc.gov/parasites/strongyloides/biology.html
Figure.....Life cycle of Strongyloides

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STEP 6: Clinical Features of Patients with Strongyloidiasis (10 Minutes)
 The vast majority of infections in endemic areas are symptomless. When, for various reasons, the number of
Strongyloides present in the intestine increases, then symptoms develop.
 Primary infection - This is rarely seen in endemic areas

o A pruritic erythematous eruption at the site of entry the larvae
o A dry cough or sore throat
o abdominal fullness,
o aching in the right lower quadrant of the abdomen
o watery diarrhoea alternating with constipation.
 Chronic uncomplicated strongyloidiasis .This is characterized by:
o epigastric and right upper quadrant pain
o nausea
o chronic diarrhea
o weight loss.
o Skin rashes: There are two types of skin rashes:
 A linear eruption larva currens in which the larvae migrate under the skin causing an itching rash
(disappears within few hours). They occur around the anus and anywhere on the trunk
 Urticaria caused by allergy to the larvae penetrating the skin in an individual who has already been
sensitized. It occurs predominantly in the buttocks, with pruritus ani, and around the waist, lasts 12
days and recurs at regular intervals.
STEP 7: Diagnostic Measures of Strongyloidiasis(05 Minutes)

 Only adults or rhabditiform larvae appear in the stools, duodenal aspirate or by the Entero test capsule. They
can be demonstrated by the faecal examination methods or cultured in charcoal at 26°C for a week
 More sensitive coprological methods - modified agar plate and the Baermann technique.
 Serological methods using ELISA, which detect serum IgG against a crude extract of infective larvae, are more
sensitive than coprology, but are labour-intensive and prone to cross-reactions with other helminthes and filariae.
 A gelatin particle indirect agglutination test is considered to be more practical than the ELISA for mass screening
for strongyloidiasis.
STEP 8: Management of Patients with Strongyloidiasis(05 Minutes)

 Since pinworms pass so easily from one person to another, everyone living in the household of an
infected person usually needs treatment at the same time to prevent re-infection.
 Caregivers and others who have close, personal contact with the individual should also receive
treatment.
 S. stercoralis should usually be treated whether or not the infection is giving rise to symptoms
 Ivermectin is highly efficacious and the drug of choice
 Generally less efficacious drugs:
o Albendazole,
o Mebendazole
o thiabendazole
 Creams or ointments can be applied soothe itching skin in the area around the anus
STEP 9: Complications of Strongyloidiasis (05 Minutes)

 Eosinophilic pneumonia: Lungs swells due to the increased amount of eosinophils
 Mulnutrition

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 Disseminated strongloidiasis: Disseminated strongyloidiasis involves widespread distribution of the parasite to
other organs the body. It commonly occurs to people with suppressed immunity.The symptoms include:
o abdominal swelling and pain
o shock
o pulmonary and neurological complications
o recurrent bacterial infection of the blood

o Strongyloidiasis thrives in conditions of overcrowding on damp soil in tropical conditions
o The life cycle is complex and involves two stages in which reproduction takes place:
 an internal sexual cycle involving parasitic worms and
 the external sexual cycle involving free-living worms
STEP 11: Session Evaluation(05 Minutes)

 What is the mode of transmission of strongyloidiasis?
 What are the complications of strongyloidiasis?
References
CDC, 2018b. Parasites-Strongyloides. Available at: https://www.cdc.gov/parasites/strongyloides/biology.html

[Accessed December 18, 2018]
DC: WHO

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SESSION 11: CARE OF A PATIENT WITH ENTEROBIASIS
Prerequisite:
 None
Learning Tasks
Define enterobiasis
Explain the epidemiology of enterobiasis
Describe mode of transmission of enterobiasis
Explain the life cycle of enterobiasis
Outline the clinical features of patients with enterobiasis
Identify diagnostic measures of enterobiasis
Manage patients with enterobiasis
Outline complications of enterobiasis
Resources Needed:

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Method
2. 05 Buzzing Definition of enterobiasis
Lecture/ Discussion
3. 05 Lecture/ Discussion Epidemiology of enterobiasis
4. 05 Lecture/ Discussion Mode of transmission of enterobiasis
5. 10 Lecture/ Discussion Life cycle of enterobiasis
6. 05 Lecture/ Discussion Clinical features of patients with enterobiasis
7. 05 Lecture/ Discussion Diagnostic measures of enterobiasis
8. 05 Lecture/ Discussion Management of patients with enterobiasis
9. 05 Lecture/ Discussion Complications of enterobiasis

SESSION CONTENTS
STEP 2: Definition of Enterobiasis (05 Minutes)

NMT
ASK05211: Management
students to pair of
upCommunicable Diseases of enterobiasis for 2 minutes
and buzz on definitions 130
WRITE their responses in the chalk/white board or flip chart 130
 Enterobiasis: is the intestinal infection caused by a small helminth called Enterobius vermicularis
o The worm is also known as threadworm and pinworm
STEP 3: Epidemiology of Enterobiasis (05 Minutes)

 Enterobiasis has a worldwide distribution
 Is one of the most common childhood helminth infections in the developed world
 E. vermicularis is more common in children than adults and occurs among all socioeconomic groups.
 It occurs in families or institutions, such as asylums and schools, especially under crowded conditions.
 When one infection is found, it is likely that there are others also
STEP 4: Mode of Transmission of Enterobiasis (05 Minutes)

 There are four possible methods of transmission:
o Direct transmission from the anal and perianal region to the mouth by fingernail contamination and by soiled
nightclothes- The most common
o Exposure to viable eggs on soiled bed linen and other contaminated objects in the environment.
o Via the mouth or nose from contaminated dust in which embryonated eggs have been detected.
o Retroinfection in which eggs hatch on the anal mucosa and larvae migrate up the bowel
STEP 5: Life Cycle of Transmission of Enterobiasis (10 Minutes)
 Life cycle of Enterobius vermicularis

o Eggs are deposited on perianal folds
o Self-infection occurs by transferring infective eggs to the mouth with hands that have scratched the perianal
area
o Person-to-person transmission can also occur through handling of contaminated clothes or bed linens.
o Enterobiasis may also be acquired through surfaces in the environment that are contaminated with pinworm
eggs (e.g., curtains, carpeting).
o Some small number of eggs may become airborne and inhaled. These would be swallowed and follow the
same development as ingested eggs.
o Following ingestion of infective eggs, the larvae hatch in the small intestine and the adults establish
themselves in the colon
o The time interval from ingestion of infective eggs to oviposition by the adult females is about one month.
o The life span of the adults is about two months.
o Gravid females migrate nocturnally outside the anus and oviposit while crawling on the skin of the perianal
area

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o The larvae contained inside the eggs develop (the eggs become infective) in 4 to 6 hours under optimal
conditions
o Retroinfection, or the migration of newly hatched larvae from the anal skin back into the rectum, may occur
but the frequency with which this happens is unknown.
Adapted from https://www.cdc.gov/parasites/pinworm/biology.html

Figure.....Life cycle of Enterobias
STEP 6: Clinical Features of Patients with Enterobiasis (05 Minutes)
o Some individuals with pinworm infections may not experience any symptoms. However, the
symptoms of enterobiasis include:
 Frequent and strong itching of the anal area
 Restless sleep due to anal itching and discomfort
 Pain, rash or other skin irritation around the anus
 The presence of pinworms in the anal area
 The presence of pinworms in stools
STEP 7: Diagnostic Measures of Enterobiasis (05 Minutes)
 The diagnosis is made by finding the characteristic eggs in the faeces, perianal scrapings or swabs from under
the fingernails, or by finding adult worms round the anus, usually at night
 A Sellotape swab has been devised with which it is possible to obtain eggs by scraping the perianal area, usually
at night
 The Scotch tape method, in which eggs adhere to a sticky surface, is very popular

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STEP 8: Management of Patients with Enterobiasis (05 Minutes)
o The whole family must be treated to avoid reinfection.
o Abendazole is the treatment of choice
o Mebendazole and pyrantel pamoate are as effective.
o Piperazine is also effective but is less well tolerated and must be given daily for 7 days.
o Treatment may need repeating every 6 weeks until the environment is clear.
o During treatment it is important to prevent reinfection.
 The child must sleep in cotton clothes and gloves and the fingernails must be kept short and scrubbed.
 Other members of the family or school should also be treated.
STEP 9: Complications of Enterobiasis (05 Minutes)
 In rare cases, if the infestation is left untreated, pinworm infections can lead to:
o Urinary tract infection in women.
o Vaginitis
o Endometritis
o Abdominal pain incase of heavy infestation
o Malnutrition

 Enterobiasis: is the infection caused by a small helminth called Enterobius vermicularis
 E. vermicularis is more common in children than adults
o When one member of the family gets infected, the whole family must be treated to avoid reinfection.
 Abendazole is the treatment of choice

 What are the clinical features of enterobiasis?
 What are the complications of enterobiasis?
Reference
CDC, 2018b. Parasite-Enterobiasis. Available at: https://www.cdc.gov/parasites/pinworm/biology.html [Accessed
December 18, 2018].
DC: WHO

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SESSION: CARE OF PATIENTS WITH RIFT VALLEY FEVER AND EBOLA
VIRUS DISEASE
Prerequisite
 None
Learning Tasks
At the end of this session a learner are expected to be able to:
Define Rift Valley Fever and Ebola Virus Disease
Explain the mode of transmission of Rift Valley Fever
Outline the clinical features of Rift Valley Fever
Outline complication related to Rift Valley Fever
Explain preventive measures of Rift Valley
Manage patients with Rift Valley Fever
Explain the mode of transmission of Ebola Virus Disease
Outline the clinical features of Ebola Virus Disease
Outline complication related to Ebola Virus Disease
Explain preventive measures of Ebola Virus Disease
Manage patients with Ebola Virus Disease
Resources Needed

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Session Overview

2. 05 Brainstorming/Presentation Definition of Rift Valley Fever and Ebola Virus
Disease
3. Lecture/Discussion Mode of transmission of Rift Valley Fever
4. Lecture/Discussion Clinical features of Rift Valley Fever
5. Lecture/Discussion Complications of Rift Valley Fever
6. Lecture/Discussion Preventive measures of Rift Valley
7. Lecture/Discussion Management of patients with Rift Valley Fever
8. Lecture/Discussion Mode of transmission of Ebola Virus Disease
9. Lecture/Discussion Clinical features of Ebola Virus Disease
10. Lecture/Discussion Complication of Ebola Virus Disease
11. Lecture/Discussion Preventive measures of Ebola Virus Disease
12. Lecture/Discussion Management of patients with Ebola Virus

Disease
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning tasks (05 Minutes)
STEP 2: Definition of Rift Valley Fever and Ebola Virus Disease (05 Minutes)

ASK each student to brainstorm on the definitions of Rift Valley Fever and Ebola Virus Disease for 2
minutes

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 Rift Valley Fever: This is a viral zoonosis caused by Rift Valley fever virus that is primarily spread
amongst animals by the bite of infected culex or aedes mosquitoes
 Ebola Virus Disease: is a viral hemorrhagic fever of humans and other primates caused
by ebolaviruses
STEP 3: Mode of Transmission of Rift Valley Fever (20 Minutes)
o This is a viral zoonosis that is primarily spread amongst animals by the bite of infected mosquitoes,
transmitting the Rift Valley virus
 Aedes mosquitoes are the main vector biting animals
o Transmission to human is through;
 Handling of animal tissue during slaughtering or butchering
 Assisting with animal births
 Conducting veterinary procedures
 Inoculation e.g via wound from infected knife or through contact with broken skin or through inhalation
of aerosols produced during the slaughter of an infected animals
 Infected mosquito.
o Human become viraemic; capable of infecting mosquitoes shortly before onset of fever and for the first 35
days of illness. Once infected, mosquitoes remain so for life.
o Mosquitoes are both a reservoir and vector

 They are able to maintain the virus for life and transmit it to offspring via eggs
o Increased levels of rainfall and flooding lead to reproduction of more virus infected mosquitoes
 These mosquitoes hatch and pass the virus to humans and animals, producing disease
o Human become infected through mosquito bites and direct contact with infected animal blood or tissue, or
through direct contact during slaughtering of infected animals and veterinary procedures (Figure )

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Source: https://www.cdc.gov/vhf/rvf/resources/virus-ecology.html
Figure . Life Cycle of Rift Valley Fever
STEP 4: Clinical Features of Rift Valley Fever (05 Minutes)

o Acute febrile illness that does not respond to antibiotic or antimalarial therapy
o Exhaustion, backache, muscle pains, headache (often severe)
o Photophobia
o Nausea/vomiting
o Evidence of bleeding into skin, bleeding from puncture wounds, from mucous membranes or nose, from
gastrointestinal tract and unnatural bleeding from vagina
o Clinical jaundice (3-fold increase above normal of transaminases)
STEP 5: Preventive Measures of Rift Valley Fever (15 Minutes)
o Health education on risk reduction should focus on:

 Reducing the risk of animal-to-human transmission as a result of unsafe animal husbandry and
slaughtering practices.
 Practicing hand hygiene, wearing gloves and other appropriate individual protective equipment when
handling sick animals or their tissues or when slaughtering animals.

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 Reducing the risk of animal-to-human transmission arising from the unsafe consumption of fresh blood,
raw milk or animal tissue.
 In the epizootic regions, all animal products (blood, meat, and milk) should be thoroughly cooked before
eating.
 Protection against mosquito bites through the use of impregnated mosquito nets, personal insect
repellent if available, light coloured clothing (long-sleeved shirts and trousers) and by avoiding outdoor
activity at peak biting times of the vector species.
o Infection control in health care settings: Although no human-to-human transmission of RVF has been
demonstrated, there is still a theoretical risk of transmission of the virus from infected patients to healthcare
workers through contact with infected blood or tissues.
 Healthcare workers caring for patients with suspected or confirmed RVF should implement Standard
Precautions when handling specimens from patients.
o Vector control: Other ways in which to control the spread of RVF involve control of the vector and protection
against their bites.
o Larviciding measures at mosquito breeding sites are the most effective form of vector control if breeding
sites can be clearly identified and are limited in size and extent.
 During periods of flooding, however, the number and extent of breeding sites is usually too high for
larviciding measures to be feasible.
STEP 6: Complications of Rift Valley Fever (05 Minutes)
 Ocular disease (diseases affecting the eye) - lesions occurring in the macula leading to approximately 50% of
patients getting permanent vision loss
 Encephalitis or inflammation of the brain, which can lead to headaches, coma, or seizures.
 Hemorrhagic fever, with approximately 50% fatality.
 Symptoms of hemorrhaging may begin with jaundice and other signs of liver impairment, followed by vomiting
blood, bloody stool, or bleeding from gums, skin, nose, and injection sites.
o These symptoms appear 2-4 days and death usually occurs 3-6 days after.
STEP 7: Mode of Transmission of Ebola Virus Disease (20 Minutes)
o Primary transmission is from animal to human, through contact with an infected animal or its product.
o Secondary transmission is from person to person through:
 Contact with a sick person or direct contact with the blood and/or secretions or with objects, such as
needles that have been contaminated with infected secretions of an infected person.
 Breast feeding
 Sexual contact
o The virus enters through broken skin, mucous membrane or exchange of bodily fluids or ingestion,
inhalation and injection of infectious material
o The disease can spread rapidly within the health care setting.
Transmission

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 The fruit bats are the reservoir of Ebola Virus
 Epizootic in animals
o Infected fruit bats enter in direct or indirect contact with other animals and pass on the infection
 Large-scale epidemics in primates or mammals (e.g. forest antelopes) can happen
 Primary human transmission (zoonosis)
o The virus can be transmitted from animal to human via contact with bodily fluids of infected sick or dead
animals; or through direct contact with infected bats
 Human to human transmission
o Secondary human-to-human transmission occurs through direct contact with the blood, secretions, organs
or other body fluids of infected persons
o High transmission risk when providing direct patient care or handling dead bodies (funerals).
 The virus Persist in body fluids of EVD survivors, thus represent a risk for sexual transmission
Source: https://www.who.int/csr/resources/publications/presentation.pdf?ua=1
Figure .Ebola Virus transmission
STEP 8: Clinical Features of Ebola Virus Disease (10 Minutes)

o Human are not infectious until they develop symptoms
 The incubation period is 2 - 21 days (with an average of 8 to 10).
o Symptoms of Ebola Virus Disease (EVD) include:
 Sudden onset of fever and fatigue, muscle pain, headache and sore throat
 Usually followed by: vomiting, abdominal pain, diarrhoea, rash, impaired kidney and liver function,
spontaneous bleeding internally and externally (in some cases).
STEP 9: Preventive Measures of Ebola Virus Disease (10 Minutes)
 While in an area affected by Ebola, it is important to avoid the following:

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o Contact with blood and body fluids (such as urine, feces, saliva, sweat, vomit, breast milk, semen, and
vaginal fluids).
o Items that may have come in contact with an infected persons blood or body fluids (such as clothes,
bedding, needles, and medical equipment).
o Funeral or burial rituals that require handling the body of someone who died from EVD.
o Contact with bats and nonhuman primates or blood, fluids and raw meat prepared from these animals
(bushmeat) or meat from an unknown source.
o Contact with semen from a man who had EVD until you know the virus is gone from the semen
 WHO recommends that male survivors of Ebola virus disease practice safer sex and hygiene for 12
months from onset of symptoms or until their semen tests negative twice for Ebola virus
o Health care workers should always practice transmission based precaution when caring for a suspected or
confirmed Ebola patient
o There are EVD experimental vaccines research is ongoing
STEP 10: Complications Related to Ebola Virus Disease (05 Minutes)

The complications of Ebola Virus Disease include the following:
 Arthralgia(joint pain)
 Ocular diseases e.g. uveitis
 Abdominal pain
 Anemia
 Alopecia(loss of heir)
 Skin disorder
 Back pain
 Headache
 fatigue

 Rift valley fever and Ebola virus disease are viral zoonotic diseases
 They are severe, often fatal illnesses in humans
 Rift Valley Fever is transmitted to human through:
o Handling of animal tissue during slaughtering or butchering
o Assisting with animal births
o Conducting veterinary procedures
o Inoculation e.g. via wound from infected knife or through contact with broken skin or through inhalation of
aerosols produced during the slaughter of an infected animals
o Infected mosquito.
 Ebola Virus Disease is transmitted to human through:
o Contact with bodily fluids of infected sick or dead animals or
o Through direct contact with infected bats
 Human to human transmission of EVD is through direct contact with the blood, secretions, organs or other body
fluids of infected persons

 What are the signs and symptoms of Ebola Virus Disease?
 What are the signs and symptoms of Rift Valley Fever?

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References
CDC, 2018. Ebola Virus Disease (EVD). Available at: https://www.cdc.gov/vhf/ebola/prevention/index.html [Accessed
December 17, 2018].
Calain, P. et al., 1999. Ebola Hemorrhagic Fever in Kikwit , Democratic Republic of the Congo :
Clinical Observations in 103 Patients. The Journal of Infectious Diseases, 179(Suppl 1), pp.1–7.
CDC, 2018. Ebola Virus Disease (EVD). Available at: https://www.cdc.gov/vhf/ebola/prevention/index.html [Accessed
December 17, 2018].
Tiffany, A. et al., 2016. Ebola Virus Disease Complications as Experienced by Survivors in Sierra Leone. Clinical
Infectious Diseases, 62(11), pp.13606.
SESSION 06: PROVIDE CARE OF A PATIENTS WITH HOOKWORM

INFECTION
Prerequisite: None
Learning Tasks
At the end of this session participants are expected to be able to:
Define hookworm infection
Identify causative agents hookworm infection
Describe mode of transmission of hookworm infection
Explain the distribution of hookworm infection
Outline the clinical features of a patient with hookworm infection
Identify the diagnostic measures of hookworm infection
Describe complications of hookworm infection
Explain prevention and control measures of hookworm infection
Manage patients with hookworm infection

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Resources Needed:
Session Overview
Method
2. 10 Lecture/Discussion Definition of hookworm infestation
3. 05 Lecture/Discussion Causative agents for hookworm infestation
4. 20 Lecture/Discussion Mode of transmission of hookworm infestation
5. 05 Lecture/Discussion Distribution of hookworm infestation
6 10 Lecture/Discussion Clinical features of a patient with hookworm

infestation
7. 05 Lecture/Discussion Diagnostic measures of hookworm infestation
8. 10 Lecture/Discussion Complications of hookworm infestation
9. 05 Lecture/Discussion Prevention and control measures of hookworm

infestation
Manage patients with hookworm infestation
10. 05 Presentation Key points

SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (05 minutes)
READ or ASK participants to read the learning objectives

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STEP 2: Definition of Hookworm Infection (05 Minutes)

ASK students to pair up and buzz on definitions of hookworm infestation
ALLOW 2 to 3 students to provide responses and let others provide
additional responses
 Hookworm infection is the intestinal infection predominantly caused by the nematode parasites Necator
americanus and Ancylostoma duodenale
o Hookworm is an infection which may vary from asymptomatic to chronic severe infection. The
chronic debilitating disease is characterized by iron deficiency anaemia, loss of protein from the
bowel leading to malnutrition.
 The disease is most common in the hot humid areas.
STEP 3: Causative Agents of Hookworm Infection (05 Minutes)

 Hookworm is caused by two types of hookworms:
o Necator americanus
o Ancylostosoma duodenale
STEP 4: Mode of Transmission of Hookworm(..Minutes)

 The mode of transmission of hookworm is by skin penetration with hookworm filariform larvae
Life cycle of hookworm

 The eggs are embryonated when passed out with faeces
 The larvae leave the faeces and burry themselves in most damp soil (Rhabditiform larvae)
 After 5 days they change to filariform
 The filarifom hide in grass or soil
 When filariform come in contact with a human bare foot they penetrate through the skin
 The filariform reach the lung via the venous system.
 In the lungs they penetrate the respiratory system to the pharynx
 Next they are swallowed and reach the duodenum
 The whole cycle takes about 40 days

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Source: https://www.medindia.net/patients/patientinfo/hookworm-infection.htm
STEP 5: Distribution of Hookworm Infection
STEP 6: Clinical Features of a Patient with Hookworm Infection (10 Minutes)

 In mild cases hookworm is asymptomatic
 Itching at the site when the larvae penetrate the skin causing dermatitis.
 Cough during lung passage
 Abdominal pain
 Dyspepsia
 Abdominal distension
 Sometimes bloody diarrhea
STEP 7: Diagnostic Measures of Hookworm (..Minutes)

 Hookworm infection is confirmed with a microscopic examination of the stool to look for ova and parasites in the
person who is seen to manifest symptoms of hookworm infection.
 To evaluate the level of infection, complete blood count is done to check for anemia and differential count to look
for eosinophilia
o High white blood cell count indicates the presence of infection.
 Specific diagnosis with PCR (polymerase chain reaction) can be employed to confirm hookworm infection.
 Chest X- ray is done to check lung involvement in hookworm infection

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STEP 8: Complications of Hookworm infection ( .Minutes)
 Anaemia
 Congestive cardiac failure in severe anaemia
STEP 9: Prevention and Control Measures of Hookworm Infection (05 Minutes)

 Use of latrine by all people
 Wearing of shoes
 Deworming campaigns or mass treatment
 Deworming of pregnant women after second trimester
 Deworming of under five children at regular intervals according to guidelines
 Health education on hookworm infection
STEP 11: Key Points

 The mode of transmission of hookworm is by skin penetration of hookworm filariform larvae
 Hookworm cause continued loss of iron resulting in anaemia
 Treatment should aim at eliminating the worms and correcting anaemia
STEP 10: Management of a Patient with Hookworm Infestations

Drugs
 Albendazole or Mebendazole (drugs of choice) or
 Ketrax (levamisole hydrochloride) 3 tablets single dose or
 Delphinium (Alco par) one sachet single dose
 Ferrous sulphate 200mg 3 times a day for children for adults to treat anaemia and once a day for children.
 High protein, vitamin and mineral diet

 What are the preventive measures of hookworm infection?
SESSION 06: CARE OF PATIENTS WITH TAPEWORM INFECTIONS

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Prerequisite: None
Learning Tasks
Define tapeworm infection
Identify causative agents tapeworm infection
Describe mode of transmission of tapeworm infestation
Explain the distribution of tapeworm infestation
Outline the clinical features of a patient with tapeworm infestation
Identify the diagnostic measures of tapeworm infestation
Describe complications of tapeworm infestation
Explain prevention and control measures of tapeworm infestation
Manage patients with tapeworm infestation
Resources Needed:
Session Overview
Method
2. 10 Lecture/Discussion Definition of tapeworm infestation
3. 05 Lecture/Discussion Causative agents for tapeworm infestation
4. 20 Lecture/Discussion Mode of transmission of tapeworm infestation
5. 05 Lecture/Discussion Distribution of tapeworm infestation
6 10 Lecture/Discussion Clinical features of a patient with tapeworm

infestation
7. 05 Lecture/Discussion Diagnostic measures of tapeworm infestation

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8. 10 Lecture/Discussion Complications of tapeworm infestation
9. 05 Lecture/Discussion Prevention and control measures of tapeworm

infection
Manage patients with tapeworm infection

SESSION CONTENTS
STEP 2: Definition of Tapeworm Infection (05 Minutes)

 Tapeworm infection is the type of parasitic infestation caused by long, segmented worms of the class
ASK students
Cestodato pair up and buzz on definition of tapeworm infection
STEP 3: Causative
CLARIFY and summarize Agents of Tapeworm
their responses using the Infestation (05 Minutes)
content below
 Tapeworm infestation (Taeniasis) is caused by the following types of tapeworm:

o Taenia Saginata (beef tapeworm)
o Taenia Solium (pork tapeworm)
STEP 4: Mode of Transmission of Taeniasis (05 Minutes)

ASK students to brainstorm on mode of transmission of tapeworm infection
 The mode of transmission of taeniasis is by ingestion of meat containing taenia cysts
STEP 5: Distribution of Taeniasis

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 Both species are worldwide in distribution
 Taenia solium is more prevalent in poorer communities where humans live in close contact with pigs and eat
undercooked pork, and in very rare in Muslim countries
STEP 6: Clinical Features of a Patient with Taeniasis (10 Minutes)

Clinical pictures
 In most cases no signs and symptoms in Taenia saginata infection
 Abdominal discomfort
 Loss of weight
 Itching around the anus
 The segments are present in stool
 Malnutrition
 Taenia solium invades the brain and the patient present with:
o Muscle pain
o Epilepsy
STEP 7: Diagnostic Measures of Taeniasis(05 Minutes)

 Microscopy Stool sample analysis for Taenia solium or Taenia sagnata progrottids/ eggs
 Palpation of readily visible subcutaneous cysts
 Imaging e.g. CT Scan, X-ray or Ultrasound for cysts
 Serological tests e.g. ELISA
STEP 8: Complications of Taeniasis (10 Minutes)

In human beings Taenia solium can cause a condition known as cysticercosis. Cysticercosis is an infection of both
humans and pigs with the larval stages of the parasitic cestode, Taenia solium
 Humans get cysticercosis either by ingestion of food contaminated with feces containing eggs of Taenia solium,
or by autoinfection.
o In autoinfection, a human infected with adult T. solium can ingest eggs produced by that tapeworm, either
through fecal contamination or, possibly, from proglottids carried into the stomach by reverse peristalsis.
 Once eggs are ingested, oncospheres hatch in the intestine, invade the intestinal wall, and migrate to striated
muscles, as well as the brain, liver, and other tissues, where they develop into cysticerci
 In humans, cysts can cause serious sequellae if they localize in the brain, resulting in neurocysticercosis which
is manifested by epileptic seizures
STEP 9: Prevention and Control Measures of Tapeworm Infection (05 Minutes)

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 Proper fecal disposal
 Treat all the infected
 Reduce tapeworm carriage by mass chemotherapy
 Meat inspection and condemn infected meat
 Educate people to eat properly cooked meat
 Educate the community on proper use of latrines
STEP 10: Management of a Patient with Tapeworm Infection

Treatment
 Drug of choice is Praziquantel single dose 5 10mg/kg
 Niclosanide 24mg (4 tablets) for adult, children 11- 34 kg 2 tablets
 Albendazole

 Taenias is caused by Taenia solium and Taenia saginata
 Taeniasis leads mulnutrition
 Serious complication of infection with Taenia solium is neurocystcercorcis

 What is the mode of infection of taeniasis?
 How do people get cystcercosis?
 What are the preventive measures of taeniasis?
References
Miquel Porta (2008). A Dictionary of Epidemiology
SESSION 05: CARE OF A PATIENT WITH AMOEBIASIS

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Prerequisite: None
Learning Tasks
Define amoebiasis
Identify causative agents of amoebiasis
Explain mode of transmission of amoebiasis
Outline signs and symptoms of patients with amoebiasis
Identify diagnostic measures of amoebiasis
Enumerate complication of amoebiasis
Outline prevention and control measures of amoebiasis
Manage patients with amoebiasis
Resources Needed:
Session Overview
Method
1. 05 Presentation Introduction, Learning Objectives
2. 10 Brainstorming Definition of Amoebiasis
3. 20 Lecture/Discussion Causative agents of amoebiasis
Mode of transmission of amoebiasis
Signs and symptoms of patients with amoebiasis
Diagnostic measures of amoebiasis
4. 05 Lecture/Discussion Complication of amoebiasis
5. 10 Lecture/Discussion Prevention and control measures of amoebiasis
Management of patients with amoebiasis


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SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Objectives (05 Minutes)
STEP 2: Definition of Amoebiasis (05 Minutes)

ASK students to pair up and buzz on definitions of amoebiasis
 Amoebiasis is an infection caused by a protozoa amoeba Entamoeba histolytica characterized by abdominal

discomfort and diarrhea
STEP 3: Mode of Transmission of Amoebiasis (..Minutes)

 Infective cysts are passed from one person to another by the faecal oral route through contaminated fingers
or food
o The infective Entamoeba histolytica cysts are ingested
STEP 4: Signs and Symptoms of Patients with Amoebiasis (5 Minutes)

 The onset is insidious
o Abdominal discomfort
o Mild diarrhoea
o Tenderness over the caecum
 In severe cases
o The onset is sudden onset with :
 The patient is ill and toxic
 Fever
 The stool contain a lot of blood streaked mucous
 Signs of dehydration
 Faeces containing altered blood
 In chronic amoebiasis
o There is alternating diarrhea and constipation
STEP 5: Diagnostic Measures of Amoebiasis (10 Minutes)

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STEP 6: Complications of Amoebiasis
STEP 8: Management of Patient with Amoebiasis

Drugs
 Give Metronidazole 800mg for 3 times a day for 5 days OR
 Trinidazole2g dialy for 3 days
 Diloxanide furoate 500mg 3 times a day for 10 days to eradicate the parasites from the bowel
STEP 7: Prevention and Control Measures of Amoebiasis

 Food and hand hygiene
 Construction and proper use of latrine
 People employed with food handling should be screened regularly
 The rest of the measures is as for other faecal oral diseases

 Amoebiasis is transmitted through feacal oral route by contaminated food or water by cysts and the parasites
penetrating through the sub- mucus of the colon
 Prevention include:
o Food and hand hygiene, boiling of drinking water
o Proper faecal disposal
o Screening and treatment of food handlers etc.
STEP 7: Evaluation (5 Minutes)

 What is amoebiasis?
 What are the clinical features of amoebiasis?
References
Allender J, Spradley B. (2001) Community Health Nursing: Concepts and practice fifth
edition. Philadelphia. New York. Baltimore: Lippincott
Basavanthappa B, (2006) Community health nursing second edition New Delhi: Jaypee
brothers
Byrne,M, Bennett,F (1986). Community Nursing in develping countries: A manual for the community nurse,
second edition. Great Britain: Oxford University
Heymann D. (2008). Control of communicable diseases manual, nineteenth edition.Washington DC: WHO
Ngatia, P, Tiberry,P, Oirere,B, Rabar,B, Waithaka.M. (2008) Community health, third
edition. Nairobi: AMREF

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SESSION 4: PROVIDE CARE TO PATIENTS WITH SYPHILIS AND
GONORRHEA ACCORDING TO STANDARD GUIDELINES
Learning Tasks
Define syphilis and gonorrhea
Identify causative agent of syphilis and gonorrhea
Explain epidemiological distribution of syphilis infection
Outline clinical presentation of patient with syphilis
Identify diagnostic measures for syphilis
Identify treatment of patients with syphilis
Outline preventive and control measures of syphilis
Manage patient with syphilis
Explain epidemiological distribution of gonorrhea infection
Outline clinical presentation of patient with gonorrhea
Identify diagnostic measures for gonorrhea
Identify treatment of patients with gonorrhea
Outline preventive and control measures of gonorrhea
Manage patient with gonorrhea
Resources Needed:
SESSION OVERVIEW

Method

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2. 15 Lecture/Discussion Definition of syphilis and gonorrhea
3. 10 Lecture/Discussion Causative agents of syphilis and gonorrhea
Epidemiological distribution of syphilis infection
Clinical presentation of patient with syphilis
Diagnostic measures for syphilis
Treatment of patients with syphilis
Preventive and control measures of syphilis
5. 25 Small group discussion Management of a patient with syphilis
Lecture/Discussion
6 25 Lecture/Discussion Epidemiological distribution of gonorrhea infection
7 25 Lecture/Discussion Clinical presentation of patient with gonorrhea
Diagnostic measures for gonorrhea
Treatment of patients with gonorrhea

SESSION CONTENTS
STEP 01: Presentation of Session Title and Learning Objectives (5 minutes)
STEP 02: Definition of Syphilis and Gonorrhea (15 Minutes)

 Gonorrhea: Gonorrhoea is an acute or chronic purulent infection of the genital and urinary tracts characterized
by vaginal or urethral discharge.
o Is caused by Diplococcus known as gonococcus Neisseria gonorrhoeae through unprotected sexual
contact with infected person
 The baby can contract the infection during child birth through the birth canal leading to gonococcal
ophthalmia neonatorum
 Syphilis: Syphilis is a systemic, sexually transmitted disease (STD) caused by the Treponema pallidum
bacterium
STEP 03: Causative Agent of Syphilis and Gonorrhea

 Syphilis is caused by a spirochaetes called Treponema pallidum bacterium
 Gonorrhea is caused by Diplococcus known as gonococcus Neisseria gonorrhoeae

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STEP 04: Epidemiological Distribution of Syphilis
 Treponema pallidum, the causative agent of syphilis
 Syphilis has a worldwide distribution, and like other bacterial sexually transmitted infections (STIs), it is more
common in poor populations who lack access to treatment, and in those with many sexual partners.
 The WHO estimated that 12 million new cases of venereal syphilis occurred in 1999, more than 90% of them in
developing countries, with a rapidly increasing number of cases in Eastern Europe.
 The overall prevalence of syphilis among antenatal attendees in 2003/2004 was 7.3%
STEP 05: Clinical Presentation of a Patient with Syphilis

 Patient with chancroid may present with the following clinical feature but these clinical features vary according to
the stage of the disease
 There are three main stages of syphilis infection and these are:
o Primary Syphilis
o Secondary Syphilis
o Tertiary Syphilis.
Primary Syphilis
 This occurs within a week to 3 months of initial infection and manifests itself as a hard non-painful ulcer
(chancre), which appears at site of entry of the causative organism.
 Common sites for the ulcer are genital parts, but may also appear on other parts of the body like the anus and
mouth depending on the type of sex practiced
Secondary Syphilis
 Occurs approximately 3 months up to 2 years of untreated or partially treated initial (primary) infection
o By then, the initial lesions may have healed on their own
 It may present as: Cracked lining of the mouth and genitals (Rhagades),raised flat moist and soft lesions of the
mucosa surfaces of the mouth, vulva and anus (condylomata lata)
 Both primary and secondary syphilis are very infectious. In some cases the two stages may overlap
Tertiary Syphilis
 Tertiary syphilis may remain asymptomatic for many years after initial infection (10 to 15 years) and it results
from untreated or partially treated primary and/or secondary syphilis
 During the asymptomatic period, the organisms in the body cause progressive tissue destruction and may
present in different forms as follows: Chronic inflammatory,
 Destructive noninfectious lesions of the skin, bones, viscera and mucosal surfaces, localized lesions (Gumma)
on the heart, blood vessels leading to aneurisms, lesions on the central nervous system lead to psychosis,
Gumma can also occur on labia and glans penis and liver, eyes and kidneys may be affected
STEP 06: Diagnostic Measures of Syphilis

 Darkfield examinations and other tests (e.g., PCR) to detect T. pallidum directly from lesion exudate or tissue
o A definitive method for diagnosing early syphilis and congenital syphilis (not available in most settings).
 Presumptive diagnosis requires use of 2 serologic tests:
o Non treponemal test (i.e., VDRL or RPR)

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o Treponemal test (i.e., FTA-ABS tests, the TP-PA assay, various EIAs, chemiluminescence immunoassays,
immunoblots, or rapid treponemal assays)
o Persons with a reactive non treponemal test should always receive a treponemal test to confirm the
presumptive diagnosis of syphilis.
STEP 07: Treatment of a Patient with Syphilis

 During treatment abstain from sexual intercourse
 Benzathine penicillin 2.4 MU(1.2m in each buttock) single dose
 Patients allergic to penicillin should be given doxycycline 100mg twice daily orally for 15 days
 Erythromycin can be used in pregnancy if there is allergy to penicillin
 For syphilis of longer than one year duration, use benzathine penicillin G 2.4 MU intramuscularly weekly for 3
successive week
STEP 08: Preventive and Control Measures of Syphilis

 Correct and consistent use of condoms
 Screening pregnant women for STIs
 Screen blood before transfusion
STEP 09: Epidemiological Distribution of Gonorrhoea
 In 2008, the WHO estimated global incidence of N. gonorrhoeae was 106 million cases, which
represented a 21 percent increase over the estimate for 2005.
 The highest incidence areas included Africa and the Western Pacific (including China and Australia)
regions.
 The prevalence of N. gonorrhoeae during pregnancy ranged from 1.5 percent in West and Central
Africa to 4.9 percent in East and Southern Africa.
STEP 10: Clinical Presentation of a Patient with Gonorrhea

 In males
o Irritation at the urinary meatus
o Painful micturition
o Purulent yellow and profuse discharge
o Dysuria which may be slight or severe
 In females
o About 50% of infected women have no symptoms
o Burning sensation during micturition
o Purulent yellow vaginal discharge
o Infection of Bartholins ducts
o In untreated cases the women remains infectious and spread the disease to others

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STEP 11: Diagnostic Measures of Gonorrhea
 Culture requires endocervical (women) or urethral (men) swab specimens.

 Because of its high specificity, a Gram stain of urethral secretions that demonstrates
polymorphonuclear leukocytes with intracellular Gram-negative diplococci can be considered
diagnostic for infection with N. gonorrhoeae in symptomatic men.
 In cases of suspected or documented treatment failure, clinicians should perform both culture and
antimicrobial susceptibility testing
STEP 12: Treatment of a Patient with Gonorrhea

 The Recommended First Line Treatment for Gonorrhea:
o Norfloxacin 500mg in orally in a single dose
o Ciprofloxacin 500mg orally in a single dose
o Ofloxacin 400mg orally in a single dose
o Levofloxacin 250mg orally single dose
o Ceftriaxone 250mg IM in a single single dose
o Enoxacin 400mg orally in a single dose
 Alternative or Second Line

o Cefixime 400mg orally in a single dose
o Cefoxitin 2g IM in a single dose with one gram of probenecid orally
o Cefotaxime 2g IM in a single dose
o Azithromycin 1g orally in a single dose(should not be used for pregnant patient)
 Other Treatments include:

o Cotrimoxazole 4 tablets twice daily for 2 days
o Gentamycin 80mg IM twice a day for 3 days
o Doxycycline 100mg twice a day orally for 7days
o Erythromycin 500mg 4 times a day for 7days
STEP 13: Preventive and Control Measures of Gonorrhea

 Wearing gloves when doing vaginal examinations
 Screen all pregnant women
 Avoid sharing of clothes e.g. towels

 About 50% of women infected with gonorrhea present with no symptoms

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 What are the recommended first line treatments of gonorrhea?
 What are the preventive measures of syphyllis?
References
CDC, 2015. Sexually Transmitted Diseases Treatment Guidelines , 2015. Morbidity and Mortality
Weekly Report, 64(3).
MOH, 2005. National AIDS Control Programme. HIV/AIDS/STI Surveillance Report January-December 2004: Report
Number 19,
SESSION O1: CONCEPTS OF EPIDEMIOLOGY AND DEMOGRAPHY AS

APPLIED TO COMMUNITY NURSING PRACTICE
Prerequisite:None
Learning Tasks
Define epidemiology
Explain aims of epidemiology
Identify the scope and uses of epidemiology
Explain the historical roots of epidemiology
Explain terms used in epidemic disease occurrence
Explain methods of epidemiological studies
Outline measures of health, morbidity, mortality and fertility

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Resources Needed:
Session Overview
Method
2. 05 Brainstorming Definition of epidemiology
Lecture/Discussion
3. 15 Lecture/Discussion Aims of epidemiology
4. 10 Lecture/Discussion Scope and uses of epidemiology
5. 20 Lecture/Discussion Historical roots of epidemiology
6. 15 Lecture/Discussion Terms used in epidemic disease occurrence
7. 10 Lecture/Discussion Methods of epidemiological studies
8. 30 Lecture/Discussion Measures of health, morbidity, mortality and fertility
SESSION CONTENTS
STEP 2: Definition of terms (05 minutes)

ASK students to pair up and buzz on definition of epidemiology
 Epidemiology is the study of the distribution and determinants of health-related states or events in specified
populations, and the application of this study to the control of health problems.

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STEP 3: Aims of Epidemiology (15 Minutes)
The aims of epidemiology are to:
 Describe the magnitude and distribution of the disease in the population

o Knowledge of the disease by its magnitude, distribution by place, person and time is critical for planning
health services, allocation of resources, and for training future health care providers.
 Describe disease patterns in human populations

o Identify the etiology or causes of diseases and the relevant risk factors
o The identification of the cause(s) of disease, the frequency and trend of disease occurrence, the factors that
increase a persons risk for a disease and how the disease is transmitted from one person to another or
from a nonhuman reservoir to a human population is a key in intervening to reduce morbidity and mortality
from the disease.
 Provide data for the management, evaluation and planning of services for the prevention, control and treatment
of disease.
o The collected data are the facts that inform designing, implementation and evaluation of preventive and
therapeutic measures and modes of health care delivery
 Provide the foundation for developing public health policy

o The findings of epidemiologic studies form a strong foundation in developing public health policy. The policy
may relate to environmental problems, genetic issues, and other considerations regarding disease
prevention and health promotion.
 Study the natural history and prognosis of disease

o Knowledge of natural history of disease helps to develop new modes of intervention, either through
treatments or through new ways of preventing complications. Later, the results of using such new modalities
are compared with the baseline data in order to determine whether our new approaches have truly been
effective.
STEP 4: Scope and Uses of Epidemiology (10 Minutes)

 Epidemiology is used to:
o Describe the health status of populations, and the distribution of diseases in a population
o Describe the etiological factors in causation of disease
o Record and explain diseases patterns
o Find the effective causes of illness or diseases.
 Manipulation or alterations of these effective causes can modify, control or even eradicate diseases
o Assess control measures taken against disease and feedback of control
o Evaluate the effectiveness of different treatment regimes. e.g. vaccines or drug in controlled trials
o Study and explain the natural history of disease, from good health to subclinical changes until occurrence of
clinical disease, where the outcome can be recovery (with or without disability) or death
o Provide and analyze information for planning, implementation and evaluation of health services
o To diagnose the health of the community
NMT Activity: Buzzing

05211: Management (5 minutes)
of Communicable Diseases
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ASK students to pair up and buzz on definition of epidemiology for 2 minutes 160
o To study the working of health services
STEP 5: Historical Roots of Epidemiology (20 Minutes)
Epidemiology is an oldest discipline whose roots are nearly 2500 years old, it emanated since World War II.
However the epidemiological thinking can be traced from times of Hippocrates, John Graunt, William Farr,
John Snow, and others. The contributions of some of these early and more recent thinkers are described
below.
 Hippocrates attempted to explain disease occurrence from a rational rather than a supernatural
viewpoint.
o In his essay entitled On Airs, Waters, and Places, Hippocrates suggested that environmental and
host factors such as behaviors might influence the development of disease.
 John Graunt, a London haberdasher and councilman in the 17th Century, was the first to quantify
patterns of birth, death, and disease occurrence, noting differences between males and females, high
infant mortality, urban/rural differences, and seasonal variations.
 In 1800s, William Farr built upon Graunt's work. He systematically collected and analyzed Britain's
mortality statistics.
o He developed many of the basic practices used today in vital statistics and disease classification.
o He concentrated his efforts on collecting vital statistics, assembling and evaluating those data, and
reporting to responsible health authorities and the general public.
 In the mid-1800s, John Snow the anesthesiologist was conducting a series of investigations in London
that warrant his being considered the father of field epidemiology
o Twenty years before the development of the microscope, Snow conducted studies of cholera
outbreaks both to discover the cause of disease and to prevent its recurrence.
 In the mid- and late-1800s, epidemiological methods began to be applied in the investigation of disease
occurrence
o Most investigators focused on acute infectious diseases.
 In the 1930s and 1940s, epidemiologists extended their methods to noninfectious diseases.
 The period since World War II has seen an explosion in the development of research methods and the
theoretical underpinnings of epidemiology.
 Epidemiology has been applied to the entire range of health-related outcomes, behaviors, and even
knowledge and attitudes.
 During the 1960s and early 1970s health workers applied epidemiologic methods to eradicate naturally
occurring smallpox worldwide. This was an achievement in applied epidemiology of unprecedented
proportions.
 In the 1980s, epidemiology was extended to the studies of injuries and violence.
 In the 1990s, the related fields of molecular and genetic epidemiology (expansion of epidemiology to
look at specific pathways, molecules and genes that influence risk of developing disease) took root.

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 Beginning in the 1990s and thereafter epidemiologists consider not only natural transmission of
infectious organisms but also deliberate spread through biologic warfare and bioterrorism.
 The field of epidemiology is currently challenged with emerging and re-emerging infectious diseases,
antimicrobial resistant
 Today, public health workers throughout the world accept and use epidemiology regularly to
characterize the health of their communities and to solve day-to-day problems, large and small.
STEP 6: Terms Used in Epidemic Occurrence of Diseases (15 Minutes)

 Sporadic refers to a disease that occurs infrequently and irregularly
 Endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population
within a geographic area
 Hyper endemic refers to persistent, high levels of disease occurrence.
o Occasionally, the amount of disease in a community rises above the expected level
 Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally
expected in that population in that area
o Epidemics occur when an agent and susceptible hosts are present in adequate numbers, and the agent can
be effectively conveyed from a source to the susceptible hosts
 Outbreak carries the same definition of epidemic, but is often used for a more limited geographic area.
 Cluster refers to an aggregation of cases grouped in place and time that are suspected to be greater than the
number expected, even though the expected number may not be known
 Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large
number of people
STEP 7: Methods of Epidemiological Studies (10 Minutes)

The methods employed in conducting epidemiological studies are divided into two categories:
 Quantitative methods
o Emphasize objective measurements and the statistical, mathematical, or numerical analysis of data
collected through polls, questionnaires, and surveys, or by manipulating pre-existing statistical data
using computational techniques.
o Quantitative research focuses on gathering numerical data and generalizing it across groups of people or to
explain a particular phenomenon
 Qualitative methods
o Emphasize subjective measurements or understanding of underlying reasons, opinions, and motivations
using narrative data collected using unstructured or semi-structured techniques.
o Common methods include focus group discussion, in-depth interviews, and participation/observations
STEP 8: Measures of Health, Morbidity, Mortality and Fertility (30 Minutes)
Measures of Health

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 Health is a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity.
 The conventional indicators employed by WHO in measuring health include:
o Life expectancy
o morbidity
o mortality
Measures of Morbidity
 The following are the common measures of morbidity:
o Incidence rate: Indicates the number of new events in a certain population at risk of such events during a
specified period of time.
o Cumulative incidence
 In the case of a fixed cohort with hardly any withdrawals, the calculation of cumulative incidence will be
as follows:
Number of new cases
Number of individuals at risk at the beginning of the study
o Attack rate: Is a form of incidence that measures the proportion of persons in a population who experience
an acute health event during a limited period (e.g., during an outbreak).
o Prevalence rate: Is the proportion of persons in a population who have a particular disease or attribute at a
specified point in time or over a specified period of time.
Measures of Mortality
 The following are the common measures of mortality:
o Crude Death Rate: Total number of deaths in a defined population in a given time period divided by the total
population
o Age Specific Death Rate: Number of deaths of a specific age group divided by number of persons in the
population of that age group
o Infant mortality rate: Number of live born infants under the age of 1 year that died during a year divided by
number of live births dying during a year
o Maternal Mortality Ratio: Number of deaths assigned to puerperal causes (i.e., childbearing) in a calendar
year divided by the number of live births in that year.
o Case Fatality Rate: Number of individuals died during a period of time from a specific disease/condition
divided by the number of individuals suffering the same disease/condition
o Proportionate Mortality Rate: Number of deaths assigned to a specific cause in a calendar year, divided by
the total number of deaths in that year (usually expressed as a percentage)
o Years of Potential Life Lost (YPLL): Is an estimate of the average years a person would have lived if he or
she had not died prematurely.
Measures of Fertility
 Common measures of fertility include:
o Crude Birth Rate : The number of live births in a year divided by the total population
 Is called rate but in practice it is a ratio
o Fertility Rate/General Fertility Rate: Number of live births in a year divided by the mid-year population of
women aged 15-49
o Total Fertility Rate: Is the average number of children a woman would have during her reproductive lifetime,
given that current specific fertility rates would still be applicable at that time.

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 Number of live births divided by the number of women in each age interval
 Epidemiology is the study of the distribution and determinants of health-related states or events in specified
populations, and the application of this study to the control of health problems.
 Quantitative methods focuses on gathering numerical data and generalizing it across groups of people or to
explain a particular phenomenon
 Qualitative methods emphasize subjective measurements or understanding of underlying reasons, opinions, and
motivations using narrative data collected using unstructured or semi-structured techniques

 What are the uses of epidemiology?
 What are the measures of morbidity?
 What are the measures of mortality?
References
Babbie, Earl R, 2010. The Practice of Social Research 12th ed., Belmont, CA: Wadsworth Cengage,
Muijs, Daniel, 2010. Doing Quantitative Research in Education with SPSS 2nd ed., London: SAGE
Publications

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SESSION 02: DEMOGRAPHIC DATA AND VITAL STATISTICS AS
APPLIED IN COMMUNITY HEALTH
Prerequisite: None
Learning Tasks
Define demography, population, data and vital statistics
Identify the uses of vital statistics
Outline importance of demographic data
Explain the uses of population pyramids in presenting demographic data
Identify the elements of demography
Explain major demographic processes
Resources Needed
Session Overview

2. 15 Buzzing Definition of demography, population, data and
Lecture/Discussion vital statistics

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3. 10 Lecture/Discussion Uses of vital statistics
4. 05 Lecture/Discussion Importance of demographic data
5. 25 Small group discussion Uses of population pyramids in presenting
Lecture/Discussion demographic data
6. 30 Lecture/Discussion Elements of demography
7. 20 Lecture/Discussion Major demographic processes
SESSION CONTENTS
STEP 2: Definition of Terms (15 Minutes)

ASK students to pair up and buzz on definition of demography, population,
data and vital statistics for 5 minutes
ALLOW 2 to 3 students to provide responses and let others provide
additional responses
 Demography
o Is the science that studies human population (Demos = population, Graphy= picture)
o Is the study of populations, especially with reference to size and density, fertility, mortality, growth, age
distribution, migration, and vital statistics, and the interaction of all these with social and economic
conditions
o Is the scientific study of the current state and changes over time in size, composition, and distribution of
populations
 Population
o All the inhabitants of a given country or area considered together
o The number of inhabitants of a given country or area
 Data
o A collection of items of information

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o Is the fact and statistics collected together for reference or analysis
 Vital statistics
o Is the information concerning births, marriages, divorces, separations, deaths migrations in and out of the
country and other fundamental quantities related to population based on registrations of these vital events
STEP 3: Uses of Vital Statistics (10 Minutes)

Vital statistics are used in:
 Health policy and health research

o Social inequalities in health, mortality trends, fertility rates
 Population projections and estimates
o Population and fiscal projections
o Population estimates and projections
 Health planning
o Based on the estimated population size, mortality and morbidity rates
STEP 4: Importance of Demographic Data (05 Minutes)

Demographic data are used in:
 Knowing health status of a community
 Planning of health services for example:
o How many health units do we need?
o How to distribute health units in the community in order to be accessible to the target population?
o What type of manpower is needed?
Step 5: Uses of Population Pyramids in Presenting Demographic Data (25 Minutes)

 Population pyramids consist of bars representing age groups in ascending order
o The length of the bar corresponds to the number of people in the age group
o The bars represent age bands of 5 year-intervals
o Male bars appear on left of the central vertical axis
 Population pyramids are used to indicate:
o Birth rate
 Pyramid that has a wide base has a high birth rate
 Developed country with good health care, low birth rate and high life expectancy will have a relatively
narrow base, and there will be similar number of people in all the bands up until the age of 70, when the
numbers will start to fall
o Migration and Mortality rates

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 Mortality and migration can be represented by the slope of the sides. The decrease in the width of
strata of different ages is brought about by deaths or emigration. The sharper the slope, as it goes
upwards, the higher are these reducing forces.
 If the numbers rapidly decrease to form a triangular shaped pyramid, then there must also be fairly high
death rates
o The life span

 Is represented by the height of the pyramid, while the shape of apex (narrow or wide) indicates the
percentage of individuals, who survive till advanced ages during their life journey
o Dependent population
 These are the groups of people who rely on the economically active members of society.
 Dependants are classified as those under working age (0 - 15 years old) and those who retired (over
60). They rely on the working age group of people between 15 and 60
 Young dependency is represented by the surface area below the horizontal line passing through 15
years of age
 Old dependency is represented by the surface area above the horizontal line passing through 60 years
of age
o Planning for the future

 Population pyramids can be used to help planning for the future, as they can be used to project the
percentages of certain age groups in the population over the next 50 years

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Figure .Population Pyramids for a Developing and Developed Countries
STEP 6: Elements of Demography (30 Minutes)

The following are elements of demography:
 Distribution of the population: It is the arrangement of the population in space at a given time i.e.
geographical distribution.
 Composition of the population: The distribution of the population by:
o Age
o Sex
o Marital state
o Education
o Occupation
o Economic status etc.
 Size of the population: Size of the population at any given time is obtained by enumeration of all persons in
the community, which is called census. There are two types of census namely, defacto and de-jure.
o Defacto census: This is counting individuals wherever they actually are on the day the census is
conducted
 Refer the census main question: How many people spent a night in the household on the census
reference night?
 Is much easy, less expensive and more economic to apply than de-jure type
 The disadvantages are persons in transit may not be included, provision of incorrect picture of the
population and vital rates may be distorted
o De-jure Census: Counts persons who usually live in the household whether present on a census day
or not.
 It gives a true figure regarding size of the population
 The disadvantages include, expensive in time and money, some individuals may be counted twice
and also Information may be incomplete
STEP 7: Major Demographic Processes (20 Minutes)

The following are the major demographic processes:
 Population Dynamics
o The number of people in a society is determined by:
 Fertility rate: The fertility rate of a society is a measure noting the number of children born. The
fertility number is generally lower than the fecundity number, which measures the potential number
of children that could be born to women of childbearing age
 Mortality rate: is a measure of the number of people who die

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 Migration: is the change of residence of a person or group of persons for better life,higher standard
of living or refuge.
 Migration may take the form of immigration, which describes movement into an area to take up
permanent residence, or emigration, which refers to movement out of an area to another place of
permanent residence.
 Population Growth
o The population grows according to two factors: birth rate and death rate
o The difference between birth rate and death rate is called the rate of natural increase
 The natural increase in size of any population is the product of subtraction of deaths from births

 Health status of a community depends upon the dynamic relationship between number of people, their
composition and distribution.
 Demography encompasses the study of the size, structure and distribution of these populations, and
spatial and/or temporal changes in them in response to birth, migration, aging and death.
STEP 7: Evaluation (5 Minutes)

 What are the two (2) importance of demography?
 What are the two types of census?
 What are the elements of demography?
References
Bonita, R., Beaglehole, R., & Kjellstrom, T. (2006). Basic epidemiology Second. Geneva,
Switzerland: WHO
SESSION 03: OVERVIEW OF SEXUALLY TRANSMITTED

INFECTIONS ACCORDING TO STANDARD
GUIDELINES
Prerequisite:
 None

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Learning Tasks
Define sexually transmitted diseases (STDs) and sexually transmitted infections (STIs)
Identify risk factors for sexually transmitted infections
Identify syndromic classification of sexually transmitted infections
Outline general clinical presentation of patient with sexually transmitted infections
Enumerate common diagnostic measures for sexually transmitted infections
Outline main techniques applied in control and prevention of sexually transmitted
infections
Counsel the client with sexually transmitted infections
Resources Needed:
Session Overview
Method
2. 10 Buzzing Definition of sexually transmitted diseases and
sexually transmitted infections
3. 50 Lecture/Discussion Risk factors for STIs
4. 05 Lecture/Discussion Syndromic classification of sexually transmitted
infections
5. 35 Lecture/Discussion General clinical presentation of patient with
sexually transmitted infections
6. 05 Lecture/Discussion Common diagnostic measures for sexually
transmitted infections
7. Main techniques applied in control and prevention
of sexually transmitted infections
8. Counselling the client with sexually transmitted
infections

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SESSION CONTENTS

STEP 02: Definition of Terms (05 Minutes)

 ASK students to pair up and buzz on definition of sexually transmitted diseases (STDs) and sexually
transmitted infections (STIs)
 WRITE their responses in the chalk/white board or flip chart
 CLARIFY and summarize their responses using the content below
 Sexually transmitted diseases (STDs): Sexually Transmitted Diseases (STDs): are diseases that are
predominantly transmitted through unprotected sexual contact with an infected person.
 Sexually transmitted Infections (STIs): Are a group of infections that are predominantly transmitted through
unprotected sexual contact with an infected person.
STEP 03: Risk Factors for STIs (..Minutes)

 Risky sexual behaviours such as
o Having multiple partners
o Changing partners
o Having sexual contact with casual partners/transactional sex workers
o Not practising safe sex (condoms are not used due to dislike, unavailability, unaffordability,
cultural/religious beliefs, myths)
o Alcohol and drug abuse resulting to impaired wise decision-making in sexual matters
 Socio-economic
o Occupation (professions that force persons to be away from their sexual partners for a long time)
o Transactional sex: Exchanging sex for money, materials and favours
o Lack of information on STIs
 Cultural
o Female genital mutilation (FGM)
o Rituals such as cleansing, widow inheritance
 Biological
o Age (adolescence/youth are at most risk)
o Gender (females are more likely to be infected compared to males)
 Political
o War and political instability create mobility and migration that adversely influences change in sexual
behaviour.
 Iatrogenic
o Infections are more common where there are many STIs, and where health care providers do not have
the training or supplies to perform procedures safely.

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 Endogenous
o Yeast infection and bacterial vaginosis, are common worldwide and are influenced by environmental,
hygienic, hormonal and other factors.
STEP 04: STI Syndromic Classification

Although STIs are caused by many different organisms/agents, these organisms give rise to a limited number of
syndromes. The common STI syndromes are:
 Urethral Discharge Syndrome (UDS)

 Painful Scrotal Swelling (PSS) (acute epididymoorchitis)
 Vaginal Discharge Syndrome (VDS)
 Pelvic Inflammatory Disease (PID)(Lower Abdominal Pain)
 Genital Ulcer Disease (GUD)
 Inguinal Bubos
 Neo-natal Conjunctivitis (Opthalmia neonatorum)
STEP 05: General Clinical Presentation of Patients With STIs

 Most STIs are symptomatic. They can present with one or more of the following symptoms and signs:
o Vaginal discharge
o Urethral discharge
o Abdominal pain
o Genital ulceration
o Genital itching
o Swelling of inguinal lymph nodes
o Scrotal swelling
STEP 06: Common Diagnostic Measures for STIs
 Microscopy-direct detection of microorganisms

 Serological tests for antigen detection from a blood sample of patient with STI
 Culture: microorganism from a sample such as urethral or vaginal discharge taken from a patient are
allowed to reproduce and multiply in predetermined culture medium under controlled laboratory conditions
.
STEP 07: Main Techniques Applied in Control and Prevention of STIs
 Training of service providers
 Effective primary prevention of STIs
 Promotion of appropriate STIs/RTIs care seeking behaviour
 Effective case management
 Contact management
 Routine prevention of ophthalmia neonatorum
 Availability and affordability of drugs
 STI case finding and screening
 Monitoring and supervision

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STEP 08: Counselling the Clients with STIs
 Health care providers have an important role to play in supporting women and men to adopt effective
prevention strategies
 Effective counseling must deal with issues of risk and vulnerability:
o Try to understand how a persons situation may increase risk and vulnerability. Understand that there
may be circumstances in a persons life that are difficult to change (for example, alcohol use, sex work
for survival) and that may make safer sex difficult
o Provide information. Give patients clear and accurate information on risky behaviours, the dangers of
STI, and specific ways to protect themselves
o Identify barriers. What keeps someone from changing behaviour? Is it personal views, lack of
information, or social restraints such as the need to please a partner? Which of these can be changed
and how?
o Help people find the motivation to reduce their risk. People often change behaviour as a result of
personal experience. Meeting someone who has HIV/AIDS, hearing about a family member or friend
who is infertile due to an STI/RTI, or learning that a partner has an infection are experiences that can
motivate someone to change behaviour
o Establish goals for risk reduction. Set up short- and long-term goals that the patient thinks are realistic
o Offer real skills. Teach negotiation skills, demonstrate how to use condoms, and conduct role-playing
conversations
o Offer choices. People need to feel that they have choices and can make their own decisions. Discuss
substitute behaviours that are less risky
o Plan for setbacks. Rehearse how to deal with a difficult situation (for example, the husband/partner
becomes angry or refuses to use condoms)

 Direct disease transmission involves direct contact or droplet spread while
indirect disease transmission involves airborne transmission, vehicles () and
vectors

 Mention strategies for disease control
References
CDC, 2015. Sexually Transmitted Diseases Treatment Guidelines , 2015. Morbidity and
Mortality Weekly Report, 64(3).
MOH, 2005. National AIDS Control Programme. HIV/AIDS/STI Surveillance Report
January-December 2004: Report Number 19,

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SESSION 03: CARE OF CLIENTS WITH URETHRAL DISCHARGE
SYNDROME AND VAGINAL DISCHARGE SYNDROME
Learning Tasks
At the end of this session participantsTotal Session
are expected Time:
to be able to: 120 minutes
Define urethral discharge syndrome (UDS) and vaginal discharge syndrome (VDS)
List the causes of UDS
Prerequisite: None
Outline the clinical manifestations of UDS
Explain the nursing management of a patient with UDS
List complications of UDS
List the causes of VDS
Outline the clinical manifestations of VDS
Explain the nursing management of a patient with VDS
List complications of VDS
Resources Needed:

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Session Overview

2. Buzzing Definition of urethral discharge syndrome
Lecture/Discussion (UDS) and vaginal discharge syndrome (VDS)
3. Lecture/Discussion Causes of UDS
4. Lecture/Discussion Nursing management of patients with UDS
5. Lecture/Discussion Complications of UDS
6. Lecture/Discussion Causes of VDS
7. Lecture/Discussion Nursing management of patients with VDS
8. Lecture/Discussion Complications of VDS

SESSION CONTENTS

STEP 2: Definition of Urethral Discharge Syndrome and Vaginal Discharge

Syndrome (05 Minutes)

 ASK students to pair up and buzz on definition of urethral discharge syndrome and vaginal
discharge syndrome for 2 minutes
CLARIFYDischarge
  Urethral and summarize their(UDS)
Syndrome responses
refersusing
to thethe contentofbelow
presence abnormal secretions in the distal
portion of the urethra
 Vaginal Discharge Syndrome (VDS) refers to change of colour, odour and/or amount of vaginal
secretions
STEP 3: Causes of Urethral Discharge Syndrome (5 Minutes)
 Neisseria gonorrhoeae
 Chlamyidia trachomatis

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 Trichomonas varginalis
STEP 4: Clinical Manifestations of Urethral Discharge Syndrome (5 Minutes)
 Urethral discharge
 Painful micturition or burning sensation
 Itchy urethra
 Increased frequency and urgency of micturation
STEP 5: Nursing Management of a Patient with Urethral Discharge Syndrome

(10 Minutes)
 Proper history taking

 Proper physically examination
o Ask the client to milk the urethra
 Treatment /drugs if urethral discharge confirmed
o Ciprofloxacin tabs. 500mg oral stat
o Doxycycline tabs 100mg oral bid for 7 days
 Educate on the importance of drug compliance
 Provide health education on the disease and its prevention
 Record number of contacts/ partner
 Proper management and follow up/referral to all
 Promote and provide condom
 Offer HIV counseling and testing
 Advice to return after 7 days for follow up or as need arise
Remember: to refer the client if no improvement during the Third visit
STEP 6: Complications of Urethral Discharge Syndrome (5 Minutes)

 The following are the complications of UDS:
o Orchitis
o Epidydimitis
o Urethral stricture
o Infertility
STEP 8: Causes of Vaginal Discharge Syndrome (5 Minutes)
 Chlamydia trachomatis
 Trichomonas vaginalis
 Candida ablicans
 Anaerobic bacteria
STEP 4: Clinical Manifestations of Vaginal Discharge Syndrome (5 Minutes)

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 ASK students to pair up and buzz on clinical manifestations of vaginal discharge syndrome for 2
minutes
 Abnormal vaginal discharge

 Burning or painful micturition
 Itchy vulva
 Increased frequency of micturition
 Painful coitus
STEP 5: Nursing Management of a Patient with Vaginal Discharge Syndrome

(20 Minutes)
 Take history
 Inspect or examine genitalia, use speculum if available
 Proper physical examination
 Treatment
o If non- curd like discharge noted treat for Gonorrhea, Chlamydia and Trichomonas
 Ciprofloxacin tabs. 500mg oral stat
 Doxycyline tabs100mg oral bd for 7 days
 Metronidazole tabs 2g oral stat
o If only curd like discharge noted treat for Candidiasis
 Clotrimazole pessaries 100mg once daily for 6 days
 Educate on importance of drug compliance
 Provide health education including body hygiene
 Counsel on risk reduction
 Offer HIV counseling and testing (PITC)
 Proper management and follow up/referral for all
 Tracing and treatment of all the persons sexual contacts is important to avoid re-infection
 Management of VDS during second visit
o Take history
o Physical examination
o If no improvements give the following drugs: Clotrimoxazole pesaries 100mg daily
o for 6 days if there is curd like discharge
o Give Second line treatment as follows:
o Inj. Ceftriaxon 250mg I.M. stat.
o Doxycyline tabs 100mg oral bd for 7 days
o Metronidazole tabs 400mg oral b.i.d for 7 days

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 Management of VDS during third visit
o Take history
o Examine the client
 If no improvement refer to laboratory for examinations
 If cured discharge the patient from clinic
 If has other STIs- manage them accordingly
STEP 6: Complications of Vaginal Discharge Syndrome (5 Minutes)

 The following are the complications of VDS:
o Infertility
o Ectopic pregnancy
o Chronic lower abdominal pains
o Dysmenorrhea
o Pelvic Abscess
STEP 11: Key Points: (5 Minutes)

 Signs and symptoms of VDS are: Abnormal vaginal discharge, painful micturition, increased
frequency micturition, itchy vagina and painful coitus
 Signs and symptoms of UDS include: Urethral discharge, painful micturition or burning
 and itchy urethra
 UDS and VDS complicate to infection to the reproductive organs resulting to infertility,
 Treatment of UDS and VDS include partner (s) tracing and treatment

 What are the drugs used for treatment of VDS during the first visit?
 What are the complications of UDS?
 What are the complications of UDS?
References
STIs Treatment guidelines - MOH
SESSION 03: SYNDROMIC MANAGEMENT OF PELVIC

INFLAMMATORY DISEASE (PID)

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Prerequisite:
 None
Learning Tasks
Define pelvic inflammatory disease (PID)
List causes of inflammatory disease
Explain Clinical manifestation of inflammatory disease
Explain syndromic management of inflammatory disease
Mention complications of inflammatory disease
List preventive measures of inflammatory disease
Resources Needed:
Session Overview

2. Buzzing Definition of pelvic inflammatory disease
Lecture/Discussion
3. Lecture/Discussion Causes of inflammatory disease
4. Lecture/Discussion Clinical manifestation of inflammatory
disease
5. Lecture/Discussion Syndromic management of inflammatory

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disease
6. Lecture/Discussion Complications of inflammatory disease
7. Lecture/Discussion Preventive measures of inflammatory disease

SESSION CONTENTS

STEP 2: Definition of Pelvic Inflammatory Disease (05 Minutes)

 ASK students to pair up and buzz on definition of pelvic inflammatory disease for 2 minutes
 PID is an inflammation of the uterus/or fallopian tubes, ovaries and pelvic peritoneum
STEP 3: Causes of Pelvic Inflammatory Disease (05 Minutes)
 Neisseria gonorrhea
 Anaerobic bacteria
STEP 4: Clinical Manifestations of Pelvic Inflammatory Disease(5 Minutes)
 Lower abdominal pain

 Abdominal tenderness
 Painful coitus
 Abdominal vaginal discharge
 Menorrhagia
 Fever
 Nausea and vomiting

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STEP 5: Nursing Management of a Patient with Pelvic Inflammatory Disease
(10 Minutes)
 Take proper history

 Proper physically examination
 Treatment (if no fever): Give the following drugs
o Ciprofloxacin 500mg stat
o Doxycycline 100mg bd for 14 days
o Metronidazole tabs. 400mg for 14 days
o Provide analgesics
 If the client has fever: Refer to the hospital
 Educate on importance of drug compliance
 Provide health education including body hygiene
 Proper management and follow up/referral of all
 Offer HIV counseling and testing
 Management of PID during second visit
o Proper history taking
o Physical examination
o If there is improvement continue with doxycycline and metronidazole
 Management of PID during third visit
o Take history and examine the patient
 If cured, discharge the patient from the clinic and advise to complete treatment
 If symptom persists, treat with second line drug ceftriaxone 250mg i.m stat
 If has other STI, treat them appropriately
STEP 6: Complications of Pelvic Inflammatory Disease (5 Minutes)
 The following are the complications of UDS:

o Infertility
o Ectopic pregnancy
o Chronic Abdominal pains
o Dysmenorrhoea and pelvic abscess
STEP 07: Prevention of Pelvic Inflammatory Disease
STEP 7: Key points (5 minutes)
 PID is an inflammation of the uterus/or fallopian tubes, ovaries and pelvic peritoneum

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 The causative organisms of PID are: Neisseria gonorrhea chlamydia trachomatis and anaerobic
bacteria
 Signs and symptoms include: Lower abdominal pain, abdominal tenderness abnormal vaginal
discharge, fever
 Management and preventive & control measures of PID is as for other STIs
 Complication of PID include infertility, ectopic pregnancy dysmenorrhoes and pelvic abscess
STEP 8: Evaluation (5 minutes)

 What are the causative organisms of PID?
 What are the signs and symptoms of PID?
References
STIs Treatment guidelines - MOH
SESSION 03: SYNDROMIC MANAGEMENT OF PAINFUL SCROTAL

SWELLING (PSS) AND INGUINAL BUBO
Prerequisite:None
Learning Tasks
Define Painful Scrotal Swelling and Inguino Bubo
Describe Painful Scrotal Swelling
Describe the Nursing Care of Painful Scrotal Swelling
Explain prevention and control measures of Painful Scrotal Swelling
Describe Inguinal Bubo
Explain the nursing care of Inguinal Bubo
Explain the preventive and control measures of Inguinal Bubo
Resources Needed:

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Session Overview

2. Buzzing Definition of Painful Scrotal Swelling and
Lecture/Discussion Inguino Bubo
3. Lecture/Discussion Causes of Painful Scrotal Swelling
Clinical manifestation of Painful Scrotal
Swelling
4. Lecture/Discussion Nursing care of Painful Scrotal Swelling
Complications of Painful Scrotal Swelling
Prevention and control measures of Painful
Scrotal Swelling
Causes of Inguinal Bubo
Clinical manifestation of Inguinal Bubo
Nursing care of Inguinal Bubo
Complications of Inguino Bubo
5. Lecture/Discussion Preventive and control measures of Inguinal
Bubo
SESSION CONTENTS

STEP 2: Definition of Painful Scrotal Swelling and Inguino Bubo (05 Minutes)
 ASK students to pair up and buzz on definition of painful scrotal swelling and inguino bubo

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 Painful Scrotal Swelling (PSS) is an inflammation of the epididymis and testis often accompanied with
scrotal pains
 Inguinal Bubo is a painful swelling of the inguinal nodes usually with pus formation
STEP 3: Causes of Painful Scrotal Swelling (05 Minutes)
STEP 4: Clinical Manifestations of Painful Scrotal Swelling (05 Minutes)
 Scrotal pains
 Swelling of the scrotum
 Tenderness
 Fever
STEP 5: Nursing Care of a Patient with Painful Scrotal Swelling (10 Minutes)
 During First Visit

o Proper history taking
o Proper physically examination
o Ask the client to milk the urethra
o Treatment /drugs if urethral discharge confirm
o Ciprofloxacin tabs. 500mg oral stat
o Doxycycline tabs 100mg oral bd for 7 days
o Educate on the importance of drug compliance
o Provide health education on the disease and its prevention
o Record number of contacts partner management and follow up/referral
o Promote and provide condom
o Offer HIV counseling and testing (PITC)
o Advice to return after 7 days for follow up or as need arise
 Second and Third Visit
o Take history
o Examine and treat for other STIs if any
o If no improvement refer to the hospital
STEP 6: Complications of Painful Scrotal Swelling (5 Minutes)
 The following are the complications of Painful Scrotal Swelling:

o Infertility
o Scrotal abscess
STEP 7: Prevention of Painful Scrotal Swelling

 Early screening for UDS

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 Early treatment of UDS
 Abstinence Avoid sexual intercourse
 Fidelity Be faithful with one partner
 Correct consistent use of condom
 Screening of STIs
 Health education on prevention of STIs and to avoid re infection
 Counseling on risk reduction
 Drug compliance
 Partner notification, referral and management
 Counseling for HIV and testing
STEP 3: Causes of Inguino Bubo (05 Minutes)
 Clomydia trachomatis
 Haemophilus ducrey
STEP 4: Clinical Manifestations of Inguino Bubo (05 Minutes)

 ASK students to brainstorm on clinical manifestations of inguino bubo
 Swelling of inguinal lymph nodes often fluctuant

 Fever
 Pain and tenderness
STEP 5: Nursing Care of a Patient with Inguino Bubo (10 Minutes)
 Take history
 Proper physical examination
 If the bubo becomes fluctuant aspirate through normal skin
 Treatment/Drugs if inguinal /femoral bubos (s) present:
o Treat for Lymphogranuloma Venerium with Erythromycin tabs. 500mg oral QID for 14 days
o If there is swollen and /or tender inguinal lyphnodes and genital ulcer treat as for Genital Ulcer Disease
(GUD)
 Educate on the importance of drug compliance
 Proper management and follow up/referral for all
 Provide HIV counseling and testing (PITC)
 Management during second visit
o Take history

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o Examine
o If no improvement refer to a hospital
STEP 6: Complications of Inguino Bubo(5 Minutes)
 The following are the complications of Painful Scrotal Swelling:

o Infertility
o Scrotal abscess
STEP 7: Prevention of Inguino Bubo( 5 Minutes)

 Early screening for UDS
 Early treatment of UDS
 Abstinence Avoid sexual intercourse
 Fidelity Be faithful with one partner
 Correct consistent use of condom
 Screening of STIs
 Health education on prevention of STIs and to avoid re infection
 Counseling on risk reduction
 Drug compliance
 Partner notification, referral and management
 Counseling for HIV and testing
STEP 7: Key points (5 minutes)

 Drugs use to treat PSS are Ciprofloxacin tabs. 500mg oral stat and
 Doxycycline tabs 100mg oral bd for 7 days. The rest of management is as for other STIs
 Drugs used in treatment of IB is Erythromycin tabs 500mg oral QID for 14 days as for
Lymphogranuloma Venerium
STEP 8: Evaluation (5 minutes)

 What are the causative organisms of Painful Scrotal Swelling?
 What are the signs and symptoms of Inguino Bubo?
References
Rosdahl R. et al. (1999) Textbook of nursing (7th ed.). Philadelphia. New York. Baltimore.
Lippincott
Nordberg E. et al, (2007) Communicable diseases: A manual for health workers in sub-
Saharan Africa. Nairobi: AMREF
Allender J, Spradley B. (2001). Community Health Nursing Concepts and Practice (5th ed)
Philadelphia. New York. Baltimore. Lippincott
Stone S, MacGuire S, Eigist D. (2002) .Comprehensive community health nursing- Family,
Aggregate& community practice (6th ed,). St. Louis London Philadelphia Sydney
Toronto. Mosby

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MOHSW (2007) National guidelines for management of sexually transmitted and
reproductive tract infections (1st ed.). Dar es Salaam: National AIDS control
programme & reproductive and child health section
SESSION 4: PROVIDE CARE TO PATIENTS WITH SYPHILIS AND

GONORRHEA ACCORDING TO STANDARD
GUIDELINES
Learning Tasks
Define syphilis and gonorrhea
Identify causative agent of syphilis and gonorrhea
Explain epidemiological distribution of syphilis infection
Outline clinical presentation of patient with syphilis
Identify diagnostic measures for syphilis
Identify treatment of patients with syphilis
Outline preventive and control measures of syphilis
Manage patient with syphilis
Explain epidemiological distribution of gonorrhea infection
Outline clinical presentation of patient with gonorrhea
Identify diagnostic measures for gonorrhea
Identify treatment of patients with gonorrhea
Outline preventive and control measures of gonorrhea
Manage patient with gonorrhea
Resources Needed:
SESSION OVERVIEW

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Method
2. 15 Lecture/Discussion Definition of syphilis and gonorrhea
3. 10 Lecture/Discussion Causative agents of syphilis and gonorrhea
Epidemiological distribution of syphilis
infection
Clinical presentation of patient with syphilis
Diagnostic measures for syphilis
Treatment of patients with syphilis
Preventive and control measures of syphilis
5. 25 Small group discussion Management of a patient with syphilis
Lecture/Discussion
6 25 Lecture/Discussion Epidemiological distribution of gonorrhea
infection
7 25 Lecture/Discussion Clinical presentation of patient with
gonorrhea
Diagnostic measures for gonorrhea
Treatment of patients with gonorrhea

SESSION CONTENTS

STEP 02: Definition of Syphilis and Gonorrhea (15 Minutes)
 Gonorrhea: Gonorrhoea is an acute or chronic purulent infection of the genital and urinary
tracts characterized by vaginal or urethral discharge.
o Is caused by Diplococcus known as gonococcus Neisseria gonorrhoeae through unprotected
sexual contact with infected person
 The baby can contract the infection during child birth through the birth canal leading to
gonococcal ophthalmia neonatorum
 Syphilis: Syphilis is a systemic, sexually transmitted disease (STD) caused by the Treponema
pallidum bacterium

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STEP 03: Causative Agent of Syphilis and Gonorrhea
STEP 04: Epidemiological Distribution of Syphilis
 Treponema pallidum, the causative agent of syphilis

 Syphilis has a worldwide distribution, and like other bacterial sexually transmitted infections
(STIs), it is more common in poor populations who lack access to treatment, and in those with
many sexual partners.
 The WHO estimated that 12 million new cases of venereal syphilis occurred in 1999, more than
90% of them in developing countries, with a rapidly increasing number of cases in Eastern
Europe.
 The overall prevalence of syphilis among antenatal attendees in 2003/2004 was 7.3%
STEP 05: Clinical Presentation of a Patient with Syphilis
 Patient with chancroid may present with the following clinical feature but these clinical features
vary according to the stage of the disease
 There are three main stages of syphilis infection and these are:
o Primary Syphilis
o Secondary Syphilis
o Tertiary Syphilis.
Primary Syphilis
 This occurs within a week to 3 months of initial infection and manifests itself as a hard non-
painful ulcer (chancre), which appears at site of entry of the causative organism.
 Common sites for the ulcer are genital parts, but may also appear on other parts of the body like
the anus and mouth depending on the type of sex practiced
Secondary Syphilis
 Occurs approximately 3 months up to 2 years of untreated or partially treated initial (primary)
infection
o By then, the initial lesions may have healed on their own
 It may present as: Cracked lining of the mouth and genitals (Rhagades),raised flat moist and soft
lesions of the mucosa surfaces of the mouth, vulva and anus (condylomata lata)
 Both primary and secondary syphilis are very infectious. In some cases the two stages may
overlap
Tertiary Syphilis
 Tertiary syphilis may remain asymptomatic for many years after initial infection (10 to 15 years)
and it results from untreated or partially treated primary and/or secondary syphilis
 During the asymptomatic period, the organisms in the body cause progressive tissue destruction
and may present in different forms as follows: Chronic inflammatory,
 Destructive noninfectious lesions of the skin, bones, viscera and mucosal surfaces, localized
lesions (Gumma) on the heart, blood vessels leading to aneurisms, lesions on the central nervous

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system lead to psychosis, Gumma can also occur on labia and glans penis and liver, eyes and
kidneys may be affected
STEP 06: Diagnostic Measures of Syphilis
 Darkfield examinations and other tests (e.g., PCR) to detect T. pallidum directly from lesion
exudate or tissue
o A definitive method for diagnosing early syphilis and congenital syphilis (not available in
most settings).
 Presumptive diagnosis requires use of 2 serologic tests:
o Non treponemal test (i.e., VDRL or RPR)
o Treponemal test (i.e., FTA-ABS tests, the TP-PA assay, various EIAs, chemiluminescence
immunoassays, immunoblots, or rapid treponemal assays)
o Persons with a reactive non treponemal test should always receive a treponemal test to
confirm the presumptive diagnosis of syphilis.
STEP 07: Treatment of a Patient with Syphilis
 During treatment abstain from sexual intercourse

 Benzathine penicillin 2.4 MU(1.2m in each buttock) single dose
 Patients allergic to penicillin should be given doxycycline 100mg twice daily orally for 15 days
 Erythromycin can be used in pregnancy if there is allergy to penicillin
 For syphilis of longer than one year duration, use benzathine penicillin G 2.4 MU intramuscularly
weekly for 3 successive week
STEP 08: Preventive and Control Measures of Syphilis

 Screening pregnant women for STIs
 Screen blood before transfusion
STEP 09: Epidemiological Distribution of Gonorrhoea
 In 2008, the WHO estimated global incidence of N. gonorrhoeae was 106 million cases, which
represented a 21 percent increase over the estimate for 2005.
 The highest incidence areas included Africa and the Western Pacific (including China and
Australia) regions.
 The prevalence of N. gonorrhoeae during pregnancy ranged from 1.5 percent in West and
Central Africa to 4.9 percent in East and Southern Africa.
STEP 10: Clinical Presentation of a Patient with Gonorrhea

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 In males
o Irritation at the urinary meatus
o Purulent yellow and profuse discharge
o Dysuria which may be slight or severe
 In females
o About 50% of infected women have no symptoms
o Burning sensation during micturition
o Purulent yellow vaginal discharge
o Infection of Bartholins ducts
o In untreated cases the women remains infectious and spread the disease to others
STEP 11: Diagnostic Measures of Gonorrhea
 Culture requires endocervical (women) or urethral (men) swab specimens.

 Because of its high specificity, a Gram stain of urethral secretions that demonstrates
polymorphonuclear leukocytes with intracellular Gram-negative diplococci can be considered
diagnostic for infection with N. gonorrhoeae in symptomatic men.
 In cases of suspected or documented treatment failure, clinicians should perform both culture
and antimicrobial susceptibility testing
STEP 12: Treatment of a Patient with Gonorrhea
 The Recommended First Line Treatment for Gonorrhea:

o Norfloxacin 500mg in orally in a single dose
o Ciprofloxacin 500mg orally in a single dose
o Ofloxacin 400mg orally in a single dose
o Levofloxacin 250mg orally single dose
o Ceftriaxone 250mg IM in a single single dose
o Enoxacin 400mg orally in a single dose
 Alternative or Second Line

o Cefixime 400mg orally in a single dose
o Cefoxitin 2g IM in a single dose with one gram of probenecid orally
o Cefotaxime 2g IM in a single dose
o Azithromycin 1g orally in a single dose(should not be used for pregnant patient)
 Other Treatments include:

o Cotrimoxazole 4 tablets twice daily for 2 days
o Gentamycin 80mg IM twice a day for 3 days
o Doxycycline 100mg twice a day orally for 7days
o Erythromycin 500mg 4 times a day for 7days

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STEP 13: Preventive and Control Measures of Gonorrhea

 Wearing gloves when doing vaginal examinations
 Screen all pregnant women
 Avoid sharing of clothes e.g. towels

 About 50% of women infected with gonorrhea present with no symptoms

 What are the recommended first line treatments of gonorrhea?
 What are the preventive measures of syphyllis?
References
CDC, 2015. Sexually Transmitted Diseases Treatment Guidelines , 2015.
Morbidity and Mortality Weekly Report, 64(3).
MOH, 2005. National AIDS Control Programme. HIV/AIDS/STI Surveillance
Report January-December 2004: Report Number 19,

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SESSION 01 CARE OF A PATIENT WITH SCABIES
Prerequisite: None
Learning tasks
At the end of this session each learner is expected to be able to:
Define scabies
Explain epidemiological distribution of scabies
Describe clinical features of the patient with scabies
Explain treatment for a patient with scabies infection
Explain prevention and control methods for the scabies infection
Manage a patient with scabies
Session Overview
Step Time (min) Activity/ Method Content
1. 05 Presentation Session title and Learning tasks

2. 05 Brainstorming Presentation Definition of scabies
3. 05 Lecture and Discussion Epidemiological distribution of scabies
4. 10 Lecture and Discussion Clinical features of the patient with scabies
5. 10 Presentation Treatment for a patient with scabies infection
6. 10 Lecture and Discussion Prevention and control methods for the scabies
infection
05 Presentation Management of a patient with scabies
8 05 Presentation Key Points
9 05 Discussion Session evaluation
Session Contents
Read or ask students to read the learning tasks
Ask students if they have any questions before continuing

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STEP 2: Definition of Scabies (5Minutes)
ASK students to buzz on definition of scabies

 Scabies is a parasitic infection of the skin characterized by severe itching with a typical
distribution caused by mites Sarcoptes scabiei.
Step 3: Epidemiological Distribution of Scabies (05 Minutes)

 Scabies is one of the three most common skin disorders in children, along with tinea and
pyoderma
 As The mites are distributed around the world and equally infect all ages, races, and
socioeconomic classes in different climates.
 Scabies is more often seen in crowded areas with unhygienic living conditions.
 Globally as of 2009, an estimated 300 million cases of scabies occur each year, About 110%
of the global population is estimated to be infected with scabies, but in certain populations, the
infection rate may be as high as 5080%.
Step 4: Clinical features of the patient with Scabies (10 Minutes)

 Intense itching especially at night
 Scratching
 Vesicles or tiny linear burrows containing the mites and their eggs
 . Lesions are prominent around
o fingerwebs
o anterior surfaces of wrists and elbows
o anterior axillary folds
o beltline
o thighs and external genitalia in men
 nipples
 abdomen
 lower portion of the buttocks in women.
 In infants, the
o head
o neck
o palms and soles may be involved
.

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Figure 1:Sites for scabies
Step 5: Treatment and Management of a patient with scabies infection (10

minutes)
 A number of medications are effective in treating scabies.
 Permethrin, a pyrethroid insecticide, is the most effective treatment for scabies, Ivermectin
 Give oral ivermectin is effective in eradicating scabies, often in a single dose.
o It is the treatment of choice for crusted scabies.
o Treatment should involve the entire body and household and any others who have had recent,
prolonged contact with the infested individual.
 Give antihistamines to control itch and prescription anti-inflammatory agents.
 Washed Bedding, clothing and towels used during the previous three days should be in hot water
and dried in a hot dryer.
 Bathing with water and recommended medicated soap
 Application of benzyl benzoate emulsion(BBE)
o This should be applied after taking warm bath by rubbing over the whole body and reapply after
24 hours
 Control itching by applying calamine lotion
Step 6: Prevention and Control of Scabies (10 minutes)

 The following are prevention and control measures for scabies:
o Regular bathing and washing of clothes
o Screening all infected person in the village and treat them
o Provide health education on proper personal hygiene
o Improve domestic water supply
o Screen school children, early diagnosis of scabies treatment of all infected children
o Give health education in schools on body hygiene
o Treat the whole family
Step 7: Key Points (05minutes)

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 Scabies is a parasitic infection of the skin characterized by severe itching with a typical
distribution caused by mites Sarcoptes scabiei.
 Clinical features including
o Intense itching especially at night
o Scratching
o vesicles or tiny linear burrows containing the mites and their eggs
Step 8:Session Evaluation (5minutes)

 What are the signs and symptoms of a patient with scabies?
 What are the preventive measures of scabies?
References
Gates, R. H. (2003). Infectious disease secrets (2.ed.). Philadelphia: Elsevier
.
Parasites Scabies Disease". Center for Disease Control and Prevention.
"Epidemiology & Risk Factors". Centers for Disease Control and Prevention. November 2, 2010
SESSION THE CONCEPTS OF FAECAL-ORAL DISEASES
Total Session Time: 60 Minutes

Prerequisite: None

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Learning tasks
Define faecal oral diseases
Enumerate faecal oral diseases
Explain the transmission cycle of faecal oral diseases
Explain preventive and control measures of faecal oral diseases
Session Overview

2. 05 Brainstorming Definition of faecal oral diseases
Presentation
3. 10 Lecture and Discussion Faecal oral diseases
4. 15 Lecture and Discussion Transmission cycle of faecal oral diseases
5. 15 Presentation Preventive and control measures of faecal oral diseases
Session contents
STEP 2: Definition of Faecal Oral Diseases (5min)

ASK students to buzz on definitions of faecal oral diseases

 Faecal
ALLOW 2 to 3oral
students
diseases describes
to provide a particular
responses and letroute
othersofprovide
transmission
additionalofresponses
a disease where
WRITEpathogens
their responses in the chalk/white board or flip chart
in fecal particles pass from one person to the mouth of another person.
o Faecal oral transmission of organisms occurs through contamination of hands, water and
food
o Flies also carry faecal materials
Step 3: Common Faecal oral Diseases (5 Minutes)

 Diseases which are transmissible through oral faecal route are:
o Cholera
o Typhoid fever
o Dysentery

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o Amoebiasis
o Acute gastro- enteritis
Step 4: Transmission Cycle of Faecal oral Diseases

 Contaminated food, water and hands
 Hands may become contaminated after defecation or by touching contaminated objects
 The house fly carry faecal material to human food.
The "F-diagram" (feces, fingers, flies, fields, fluids, food), showing pathways of fecaloral disease
transmission. The vertical blue lines show barriers: toilets, safe water, hygiene and handwashing.
Step 5: Preventive and Control measures of faecal oral diseases (15minutes)

 Prevention of faecal oral diseases depends on breaking the faecal oral transmission cycle
 The following are general prevention and control measures of faecal oral diseases
o Improve methods of stool disposal Use of properly constructed latrines
o Hand washing facilities should be provided outside toilets
o Fly control by proper refuse disposal, faeces disposal and covering latrines
o Proper cooking and handling of food
o Protection of water sources
o Boiling of drinking water
o Wash hands after attending to toilet, before food preparation and before eating
o Food handlers should be routinely screened and treated if necessary
o Proper washing of fruits before eating
Step 6: Key points (5minutes)

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 Faecal oral transmission of organisms occurs through contamination of hands, water and food
 Flies also carry faecal materials
o Cholera
o Typhoid fever
o Dysentery
o Amoebiasis
o Acute gastro- enteritisa
Step 7: Session Evaluation (5minutes)

 What does faecal oral diseases means?
 How will you Prevent and Control faecal oral diseases?
References
Heymann D. (2008). Control of communicable diseases manual (nineteenth edition).
Washington DC: WHO
Ngatia, P, Tiberry,P, Oirere,B, Rabar,B, Waithaka.M. (2008) Community health third
Stanhope M, Lancaster J. (2000) Community public health nursing fifth editionSt.
Philadelphia: Mosby
Stanhope, M, Lancaster J. (2000). Community public health nursing fifth edition.St.Louis
London: Philadelphia Sydney Toronto
Stone S, MacGuire S, Eigist D. (2002) Comprehensive community health nursing:
Family, Aggregate& community practce sixth edition St. Louis London Philadelphia
Sydney Toronto: Mosby
SESSION 1:CONCEPTS OF HIV AND AIDS AND KEY POPULATION

Prerequisite: None
Learning tasks
Define HIV and AIDS

Identify key population
Explain the magnitude of HIV and AIDS with regards to prevalence to general and key
population
Identify factors for HIV transmission
Explain
NMT 05211: the transmission
Management cycle Diseases
of Communicable of HIV
Outline mode of transmission of HIV 200
Explain the impact of HIV (clinically, social/psychologically and economically)
Explain the WHO stages of HIV and AIDS 200
Session Overview

2. 05 Brainstorming and Definition of HIV and AIDS
Presentation
3. 15 Lecture and Discussion Key population
4. 20 Presentation Magnitude of HIV and AIDS with regards to
prevalence to general and key population
5. 20 Lecture/Discussion Factors Influencing HIV transmission
Mode of transmission of HIV
6. 15 Presentation Replication cycle of HIV
7
8 15 Brainstorming/ Presentation Impact of HIV (clinically, social/psychologically and
economically)
9 15 Presentation WHO stages of HIV and AIDS
10 05 Presentation Key points
Session Contents
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes )
STEP 2: Definition of HIV and AIDS (05 Minutes)

ASK students to buzz on definitions of HIV and AIDS
Definition
ALLOW students to provide responses and let others provide additional responses
 HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, our
body's natural defence against illness.

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 AIDS (Acquired Immunodeficiency Syndrome) is a chronic, potentially life-threatening condition
caused by the human immunodeficiency virus (HIV).
o By damaging immune system, HIV interferes with the body's ability to fight the organisms
that cause disease.
Step 3: Key Population (15minutes)

 Key Population (KPs) are defined groups who, due to specific higher-risk behaviours, are at
increased risk of HIV irrespective of the epidemic type or local context.
 KPs have legal and social issues related to their behaviours that increase their vulnerability to
HIV.
 WHO guidelines focus on five key populations:
o men who have sex with men,
o people who inject drugs,
o people in prisons and other closed settings,
o sex workers and
o transgender people.
 The key populations are important to the dynamics of HIV transmission. They also essential
partners in an effective response to the epidemic.
Step 4: Magnitude of HIV and AIDS with Regards to Prevalence to General and
Key Population (20minutes)
 It is estimated that by 2015 there were about 36.7 million people living with HIV (PLHIV)
globally.
 1In Tanzania by 2016, it was estimated that around 1.35 million people were infected with HIV
in the country2.
 Tanzania mainland is experiencing a generalised HIV epidemic, with an HIV prevalence of
5.3% in the general population.
 Heterosexual sex is the most common route (attributing up to 80%) of all new HIV infections in
Tanzania Mainland.
 HIV prevalence is higher in sub-groups such as people who inject drugs (PWID) (16-51%) 3,
men who have sex with men (MSM) (22-42%) 4, and mobile populations and sex workers (14-
35%)5.
 Women are disproportionally more affected, with an HIV prevalence of 6.3% versus 3.9%
among men.
 The prevalence of HIV among young people aged 15-19 years was 1% (1.3% among girls, and
0.8% among boys).
 Furthermore, the percentage of women aged 20-24 infected with HIV is higher (4.4%) than that
of men (1.7%) in the same age group.6

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Step 5: Mode of Transmission and Factors Influencing HIV transmission
(20minutes)
Mode of Transmission
 Sexual transmission
 Injection drug use
 Blood and blood products
 Perinatal
Factors Influencing HIV transmission

 Infectiousness of host
o High viral load
o Advanced stages
 Susceptibility of recipient
o STIs
o Lack of circumcision,
 Gender (woman are more susceptible)
o Socio-economic factors
o Gender inequality
o Social mobility
o Poverty
o Cultural factors
o People in conflict
o Drug use
o Alcohol consumption
Step 6:Replication cycle of HIV (15minutes)
 HIV is a special family of virus known as retroviruses

 A retrovirus is any virus belonging to the viral family Retroviridae.
 They are enveloped viruses possessing a RNA genome, and replicate via a DNA intermediate.
 Retroviruses rely on the enzyme reverse transcriptase to perform the reverse transcription of its
genome from RNA into DNA, which can then be integrated into the host's genome with an
integrase enzyme.
 The virus then replicates as part of the cell's DNA
Steps
A= Attachment to host CD4 cell
R= Reverse transcription, enzyme makes viral DNA from viral RNA
I= DNA Integration, viral DNA integrates to cell nucleus material by integrase enzyme
R= Reproduction of HIV within CD4 cell
A= Assembly of viral components to make new HIV by protease enzyme
R= Release of new HIV viruses

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Step 7: The impact of HIV (15minutes)
ASK students to brainstorm answers to the question What are the impact of HIV & AIDS?
ALLOW time for them to respond
Health Impact
 HIV and AIDS pandemic predisposes people to other infections such as tuberculosis (TB) and
non-communicable diseases (NCDs), which are among the leading causes of morbidity and
mortality among the PLHIV. HIV.
 In Tanzania Mainland, where human and financial resources for the health system are
constrained, the implementation of additional care and management services for HIV infection
has added challenges to overall health system.
 Since HIV infection also affects health care personnel, an additional burden to the human
resource crisis has been noted.
Economic Impact
 There is a close relationship between HIV and AIDS and economic development. Poverty is a
powerful co-factor in the spread of HIV infections.

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 Economically and socially disadvantaged segments of the population, including women, youth,
and other marginalized groups, are disproportionately affected by the epidemic.
 Health status and death caused by AIDS are reported to have reduced the work force,
productivity, and disposable incomes in many communities.
3
Social Impact
 HIV and AIDS-related deaths among youths and middleaged adults has resulted in thousands
of orphans. AIDS is widespread in both urban and rural communities and mostly affects
persons at the peak of their sexual and productive lives.
 The death of a young adult often means loss of a familys primary income earner.
 The HIV and AIDS epidemic has caused breakdown of social networks in African societies.
 Stigma associated with HIV continues to prevail. Orphans are not only subjected to material,
social, and emotional deprivation, but also lack of opportunity for education and health care.
 Widows and orphans are deprived of their inheritance rights.
Step 8: WHO Stages of HIV and AIDS (15 Minutes)
 WHO developed a clinical classification system for predicting morbidity and mortality of infected
adults based on both clinical symptoms and lab markers and also incorporates a patient
performance scale.
 It has FOUR stages.
 It is a clinical classification tool for patients with HIV.
 Stage 1
o Asymptomatic and persistent generalized lymphadenopathy
o Performance scale 1: normal activity
 Stage 2 (CD4< 350)

o Weight loss < 10% body weight (wt)
o Minor mucocutaneous manifestations
o Herpes zoster
o Recurrent upper respiratory tract infections
o Recurrent oral ulcerations
o Performance scale 2: symptomatic, normal activity
 Stage 3
o Wt loss > 10% body wt
o Unexplained chronic diarrhea
o Unexplained prolonged fever
o Oral Candidiasis
o Pulmonary TB
o Severe bacterial infections
o Performance scale 3: bedridden <50% of day
 Stage 4
o HIV wasting syndrome
o Pneumocystis jerovic Pneumonia (PJP)
o Toxoplasmosis of brain
o Cryptosporidiosis with diarrhea

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o Cytomegalovirus (CMV)
o Oesophageal Candidiasis
o Extrapulmonary TB
o Lymphoma
o Kaposis sarcoma
o Progressive Multifocal Leukoencephalopathy (PML)
o HIV Dementia
o Performance scale 4, bedridden >50 %
Refer students to Handout 1.2: WHO clinical staging of HIV

disease in adults and adolescents
Step 9: Key Points (5minutes)

 Mode of HIV Transmission
o Sexual transmission
o Injection drug use
o Blood and blood products
o Perinatal
 Key Populations are defined groups who, due to specific higher-risk behaviours, those
are:-
 WHO guidelines focus on five key populations:
o men who have sex with men,
o people who inject drugs,
o people in prisons and other closed settings,
o sex workers and
o transgender people.
Step 10:Evaluation (5minutes)

 What is HIV?
 What is AIDS?
 What are the factors influencing HIV transmission?
References
National Guidelines for the Clinical Management of HIV/AIDS. MOH, Tanzania.
December 2017
Laeyendecker, O., Li. X., Arroyo, M. et al, "The Effect of HIV Subtype on Rapid Disease
Progression in Rakai, Uganda"13th Conference on Retroviruses and Opportunistic Infections (abstract
no. 44LB), February 2006
World Health Organization/UNAIDS. Guidance on provider-initiated HIV testing and counselling in
health facilities. May 2007. http://whqlibdoc.who.int/publications/2007/9789241595568_eng.pdf
(accessed 15 April 2010).

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World Health Organization/UNAIDS. Guidance on Provider-initiated HIV Testing and Counseling in
Health Facilities, May 2007. Geneva: WHO, 2007.
Send to IMA
Handout 1.2: WHO Clinical Staging of HIV disease in Adults and
Adolescents
Stage 1
 Clinical Stage I: Asymptomatic and Persistent generalized lymphadenopathy
Performance Scale 1: Asymptomatic, normal activity
 Stage 1 is usually asymptomatic and may go on for many years.
 However, swollen lymph nodes are commonly seen as this is where more and more
 soldiers (immune cells) are produced in an attempt to fight against the HIV.
 Maintaining a healthy lifestyle is important for maintaining good health for as long as
 possible
Stage 2
Clinical Stage II:
 Moderate unexplained weight loss (<10% of presumed or measured body weight)
 Recurrent respiratory tract infections: sinusitis, tonsillitis, otitis media and pharyngitis)
 Herpes zoster
 Angular cheilitis
 Recurrent oral ulceration (two or more episodes in last 6 months)
 Papular pruritic eruptions

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 Seborrhoeic dermatitis
 Fungal nail infections
 Minor mucocutaneous manifestations
Performance Scale 2 for stage 2: Symptomatic, normal activity
 CD4 count falls below 350, indicating that the immune system is weakening in turn infections
are seen more often than usual.
 Medication may help the patient to fight these infections and it is possible to continue with daily
life.
 Maintaining health is essential.
Stage 3
Clinical Stage III:
 Severe Unexplained severe weight loss (>10% of presumed or measured body weight)
 Unexplained chronic diarrhoea for longer than one month
 Unexplained persistent fever (above 37.6°C intermittent or constant, for longer than one
month)
 Persistent oral candidiasis
 Oral hairy leukoplakia
 Pulmonary tuberculosis (current)
 Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection,
meningitis or bacteraemia)
 Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis
 Unexplained anaemia (<8 g/dl), neutropaenia (<0.5 × 109 per litre) or chronic
thrombocytopaenia (<50×109 per litre)
Performance Scale 3 for stage 3: Bedridden, < 50% of the day during the last month
 As CD4 count drops further, more serious, debilitating Opportunistic Infections occur.
 Weight loss continues, along with a lack of energy and reduced ability to carry out daily
activities.
Stage 4:
Clinical Stage IV:
 HIV wasting syndrome
 Pneumocystis pneumonia
 Recurrent bacterial pneumonia (this episode plus one or more episodes in last 6 months)
 Chronic herpes simplex infection (orolabial, genital or anorectal of more than one months
duration or visceral at any site and at any duration)
 Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
 Extrapulmonary tuberculosis
 Kaposis sarcoma
 Cytomegalovirus infection (retinitis or infection of other organs excluding liver, spleen and
lymph nodes)
 Toxoplasmosis of the central nervous system
 HIV encephalopathy
 Extrapulmonary cryptococcosis including meningitis
 Disseminated non-tuberculous mycobacterial infection
 Progressive multifocal leukoencephalopathy
 Cryptosporidiosis (with diarrhoea lasting more than 1 month)
 Chronic isosporiasis
 Disseminated mycosis (coccidiomycosis or histoplasmosis)
 Recurrent septicemia (including non-typhoidal Salmonella )
 Lymphoma (cerebral or B-cell non-Hodgkin) or other solid HIV-associated tumours
 Weight loss is considerable.
 Performance Scale 4 for stage 4: Bedridden, >50% of the day during the last month

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 CD4 count may reach 0
Note:
 Assessment of body weight in pregnant woman needs to consider the expected weight gain of
pregnancy.
 Unexplained refers to where the condition is not explained by other causes.
 Some additional specific conditions can also be included in regional classifications (such
as reactivation of American trypanosomiasis [meningoencephalitis and/or myocarditis]) in
the WHO Region of the Americas and disseminated penicilliosis in Asia).
Handout 1.3:WHO Clinical Staging of HIV disease in children

confirmed with HIV infection
STAGE 1
 Asymptomatic
 Persistent generalized lymphadenopathy
STAGE 2
 Unexplained persistent hepatosplenomegaly
 Papular pruritic eruptions
 Lineal gingival erythema
 Extensive wart virus infection
 Extensive molluscum contagiosum
 Recurrent oral ulcerations
 Unexplained persistent parotid enlargement
 Herpes zoster
 Recurrent or chronic upper respiratory tract infections (otitis media, otorrhoea,
 sinusitis or tonsillitis)
 Fungal nail infection
STAGE 3
 Unexplained moderate malnutrition or wasting not adequately responding to standard therapy
 Unexplained persistent diarrhoea (14 days or more)
 Unexplained persistent fever (above 37.5°C intermittent or constant, for longer than one
month)
 Persistent oral candidiasis (after first 6 weeks of life)
 Oral hairy leukoplakia
 Acute necrotizing ulcerative gingivitis or periodontitis
 Lymph node tuberculosis
 Pulmonary tuberculosis
 Severe recurrent bacterial pneumonia
 Symptomatic lymphoid interstitial pneumonitis
 Chronic HIV-associated lung disease including brochiectasis
 Unexplained anaemia (<8 g/dl), neutropaenia (<0.5 × 109 per litre) and or chronic
thrombocytopaenia (<50 × 109 per litre)
STAGE 4
 Unexplained severe wasting, stunting or severe malnutrition not responding to standard
therapy
 Pneumocystis pneumonia

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 Recurrent severe bacterial infections (such as empyema, pyomyositis, bone or joint infection or
meningitis but excluding pneumonia)
 Chronic herpes simplex infection (orolabial or cutaneous of more than one months duration or
visceral at any site)
 Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
 Extrapulmonary tuberculosis
 Kaposi sarcoma
 Cytomegalovirus infection: retinitis or cytomegalovirus infection affecting another organ, with
onset at age older than one month
 Central nervous system toxoplasmosis (after one month of life)
 Extrapulmonary cryptococcosis (including meningitis)
 HIV encephalopathy
 Disseminated endemic mycosis (coccidioidomycosis,penicilliosis or extra pulmonary
histoplasmosis)
 Disseminated non-tuberculous mycobacterial infection
 Chronic cryptosporidiosis (with diarrhoea)
 Chronic isosporiasis
 Cerebral or B-cell non-Hodgkin lymphoma
 Progressive multifocal leukoencephalopathy
 HIV-associated nephropathy or cardiomyopathy

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SESSION 02 CARE OF A PATIENT WITH CHOLERA

Prerequisite: None
Learning tasks
Define cholera
Outline causative agents of cholera
Explain mode of transmission
Outline signs and symptoms of patients with cholera
Explain diagnostic measures of cholera
Identify stages of cholera
Explain complications of cholera
Outline preventive and control measures of cholera
Manage patient with cholera
Session Overview

2. 05 Brainstorming Presentation Definition of cholera and Causative agents of cholera
3. 10 Lecture and Discussion Signs and symptoms of patients with cholera
4. 05 Presentation Diagnostic measures of cholera
5. 05 Presentation Stages of cholera
6 05 Presentation Complications of cholera
7 10 Lecture and Discussion Treatment and nursing care of a patient with cholera
8 05 Lecture and Discussion Preventive and control measures of cholera
Session Contents

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STEP 2: Definition of Cholera (05 Min)

ASK students to buzz on definitions of Cholera and identify causative agent

Definition
Definition
 Cholera is an acute intestinal disease transmitted through faecal oral route, characterized
by sudden onset of profuse rice watery stool, vomiting; rapid dehydration and circulatory collapse.
Causative organism
 Cholera is caused by Gram negative organism known as Vibrio cholerae (EL Tor vibrio)
Step 3: Signs and Symptoms of Patients with Cholera (10 minutes)

 Most cholera infections are asymptomatic or cause only simple self limiting diarrhea
 The signs and symptoms occur 2- 3 days after invasion of microorganism
 Fever is low or absent
 The disease develop in three stages
Stage one
 Profuse watery stool
 Soon faecal matter disappears followed by clear fluid with mucous and rice water appearance
stool
 Vomiting at first food but later rice water vomitus
 Severe cramps in the abdomen develops due to loss of salt
Stage two
 Collapse due to dehydration
 The body becomes cold, dry skin and inelastic
 Blood pressure is low or unrecordable
 Anuria and shock
Stage three
 Diarrhoea decreases
 General condition improves
Step 4: Complications of Cholera (05 Minutes)

Dehydration and electrolytes imbalance
Malnutrition
Shock

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Step 5: Treatment and Nursing Care of a Patient with Cholera (10Minutes)
Do not refer a suspected cholera case but inform the District authority.
 Isolate the patient in a temporary unit

 Give intravenous fluid (Ringers lactate) in order to restore hydration (treat dehydration
according to classification of dehydration (Care of Diarrhoeal Diseases)
o Rehydration will save almost all cholera cases.
 Take rectal swab if possible for laboratory investigation,
 Give drugs:
o Doxycycline 300mg as a single dose
o Erythromycin500mg tds for 7 days
 Treat patient in cholera bed with the central hole through which continuous stool can pass into
the bucket containing disinfectant
 Send information to the district authority
 Keep accurate record of all cases, their progress and report to the district authority every day
 Nurse the patients as other sick patients
 Adhere to standard precautions in infection prevention and control when caring cholera patients
 Refer students to Handout 02:01 Dehydration and Rehydration,
 Refer students to Handout 02:12 Cholera bed
Step 6: Preventive and control measures of cholera (05 minutes)
 Find out the source of the diseases and transmission

 Early diagnosis and proper treatment
 Admit cholera cases in a special unit
 Give prophylaxis (doxycycline 300mg) to all members or contacts of the patients
 Conduct continuous monitoring of all aspects of the disease including collecting of the disease
morbidity and mortality rates
 Burial of cholera cases should be supervised by medical personnel
 Report to the District Medical Officer (DMO) if there is an outbreak of cholera
 Working with the village government in tracing cholera cases and assisting in educating the
community
 Health education to the community on:
o Proper use of latrine by all household members in a clean manner
o Importance of boiling drinking water
o Importance of hand washing after attending toilet, before food preparation and before eating
o Protecting food and eating utensils from flies
o Food hygiene and eating food while hot
o Cleaning the surroundings to destroy flies breeding places
o Mode of spread of cholera and its prevention

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Step 07: Key Points:( 5 minutes)
 Cholera is one of the gastrointestinal diseases caused by vibrio cholera and it is transmitted by
faecal oral route
 The typical sign of cholera is diarrhea and vomiting (rice water appearance fluid) leading to
shock
 When there is an outbreak of cholera do not refer suspected cases of cholera but notify to
DMO
 Early diagnosis and rehydration therapy will save almost all cholera cases
 Cholera is a international notifiable disease
Step 08: Evaluation (5 minutes)
 What is the management of cholera?

 How can you prevent cholera?
References
Heymann D. (2008). Control of communicable diseases manual nineteenth edition.

Washington DC: WHO
Philadelphia: Mosby
Sydney Toronto: Mosb
Handout 02.01: Dehydration and Rehydration
DEHYDRATION AND REHYDRATION
Signs and Symptoms of Dehydration
 Moderate Dehydration
 Restlessness and irritability

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 Sunken eyes
 Dry mouth and tongue
 Increased thirst
 Skin goes back slowly when pinched
 Decreased urine
 Decreased tears, depressed fontanels in infants
 Severe Dehydration
 Lethargy or unconsciousness
 Very dry mouth and tongue
 Skin goes back very slowly when pinched (tenting)
 Weak or absent pulse
 Low blood pressure
 Minimal or no urine
Rehydration
 Rehydration is the cornerstone of treatment for cholera.

 Oral rehydration salts and, when necessary, intravenous fluids and electrolytes, if administered
in a timely manner and in adequate volumes, will reduce fatalities to well under 1% of all
patients.
 Patients with severe acute malnutrition should receive oral rehydration with low-osmolarity
ORS solution instead of the standard rehydration solution for diarrhea, ReSoMal. ReSoMal
does not have sufficient sodium content to replace the losses from cholera
 Breastfed infants should continue to breastfeed.
 Other types of fluids, such as juice, soft drinks, and sports drinks should be avoided.
A man being treated for choler

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Handout 02.02: Cholera Bed

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SESSION 02 CARE OF A PATIENT WITH PEDICULOSIS
Prerequisite: None
Learning tasks
Define pediculosis
Explain epidemiological distribution of pediculosis
Describe clinical pictures of the patient with pediculosis
Explain treatment for a patient with pediculosis
Explain prevention and control methods for the pediculosis
Provide nursing care to patient with pediculosis
Session Overview

2. 05 Brainstorming Presentation Definition of pediculosis
3. 05 Lecture and Discussion Epidemiological distribution of pediculosis
4. 10 Lecture and Discussion Clinical picture of the patient with pediculosis
5. 15 Presentation Treatment and Nursing care of a patient with pediculosis
6. 10 Lecture and Discussion Preventive and control methods for the
pediculosis
Session Contents
STEP 2: Definition of Pediculosis (5Minutes)
Activity:Buzzing (2 minutes)
ASK students to buzz on definitions of Pediculosis

CLARIFY and summarize their responses using the content below 217
217
 Pediculosisis an infestation of the hairy parts of the body or clothing with the eggs, larvae
or adults of lice.
o The crawling stages of this insect feed on human blood, which can result in severe
itching.
Step 3: Epidemiological Distribution of Pediculosis (5Minutes)

 Head lice infestation is very common and is distributed worldwide.
 Preschool and elementary-age children, 3 to 11 years of age are infested most often.
 Females are infested more often than males, probably due to more frequent head to head contact.
 Body lice are also cosmopolitan but are less common and usually seen in settings of poverty, war,
and homelessness.
Step 4: Clinical Pictures of the Patient with Pediculosis (10 minutes)

 The majority of head lice infestations are asymptomatic.
 When symptoms are noted they may include
o Tickling feeling of something moving in the hair,
o Itching, caused by an allergic reaction to louse
o Irritating
o Reddish Papules
o Nits can be seen on shafts of hair
o Impetigo of the head and neck
o Enlarge lymph glands
Step 5: Treatment and Nursing Care for a Patient with Pediculosis (15minutes)
Head Lice:
 Apply carbaryl to dry hair and rub into scalp and allow to dry
 Comb and remove by washing 12 hours later
o repeat after one-week OR
 Rub 0.1 -1% lindane and scalp; allow to dry and remove by washing after 24 hours then
o repeartafter 7 days OR
 Rub 0.5% Malathion lotion into dry hair and scalp; comb and allow drying and removingby
washing after 12 hours
o Repeat after one week

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Body Lice:
 Apply 0.1-1% lindane on the affected area, allow to dry, remove by washing after 24hours
 Apply 0.5% Malathion on the affected area, allow to dry, remove by washing after 12hours
o repeart after 7-9 days.
 Instruct the client to take a warm bath and put on clean clothes, wash and iron clothing
andbeddings.
 Sock clothes and bed linen in boiling water to kill lice and nits
Pubic (crab) Lice

 Permethrin 1% cream applied to affect areas and wash after 10 minutes OR
 Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
 Malathion o.5% lotion applied for 8-12 hours and washed off
Step 6: Prevention and Control Methods of Pediculosis (10minutes)
 Provide health education regarding the importance of body hygiene

 Instruct the client to take a warm bath and put on clean clothes, wash and iron clothing
andbeddings.
 Examine school children and household contacts and treat accordingly
 Case finding by direct inspection of bodies and clothings of school children and adultsliving in
camps
 Organize school survey in cooperation with the head teacher/headmaster
 Early diagnosis and treatment of infected person
 To ensure availability of water and soap to maintain cleanliness
 Patients with pubis pediculosis should be evaluated for other STDs
 Sexual partners within the previous month should be treated
 Patient should avoid sexual contact with their patners until they have been treated and
reevaluatedto rule out persistent disease
Step 7: Key Points(5minutes).

 Pediculosis is an infestation of the hairy parts of the body or clothing with the eggs,
larvae or adults of lice.
 The crawling stages of this insect feed on human blood, which can result in severe
itching.
 Head Lice, are treated by
o Applying carbaryl to dry hair and rub into scalp and allow to dry
o Comb and remove by washing 12 hours later; repeart after one week OR
o Rub 0.1 -1% lindane and scalp; allow to dry and remove by washing after 24 hours then
repeart after 7 days.

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Step 8: Evaluation( 5 minutes)
 What are the treatment and nursing care of the patient with
 Head Lice:?
 Body Lice?
 Pubic (crab) Lice?

Washington DC: WHO
Philadelphia: Mosby
SESSION 2 METHODS/APPROACHES IN HIV AND AIDS PREVENTION

Prerequisite: None
Learning tasks
Outline HIV and AIDS prevention measures
Explain the HIV and AIDS prevention measures
Explain approaches in HIV and AIDS prevention

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Session Overview
Step Time Activity/ Method Content
(min)
2. 10 Brainstorming Presentation HIVand AIDS prevention measures
3. 15 Brainstorming, Lecture/Discussion HIVand AIDS prevention measures ABC concept
4. 15 Presentation Approaches in HIV and AIDS prevention
6. 05 Lecture/Discussion Evaluation
Session Contents
STEP 2: HIV and AIDS Prevention Measures(10minutes)

ASK a pair ofstudents to buzz on HIVand AIDS prevention measures
responses
The following are the HIV and AIDS prevention measures are:
 HIV counseling and testing
 Treatment and prevention of STI
 Prevention of Mother to Child Transmission (PMTCT)
 ABC approach
 Circumcision
 Safe Blood supply
 Post Exposure Prophylaxis (PEP)

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 Media
Step 3: HIV and AIDS Prevention Measures ABC Concept (15minutes)

WRITE the letters ABC on the flip chart
ASK Learners if they know the meaning of these letters in the context of HIV and
ALLOW 2 to 3 students to provide responses
.
ABC approach in relation to HIV and AIDS Prevention
 Abstinence
o Not engaging in sexual acts/intercourse; delay of sexual debut
o Important in young people:1/2 of new infections occur in the 15-24 age group
o Surveys show: 40% of women in sub-Saharan Africa (SSA) have premarital sex before age
20, more common in young men
o Not all women or men have control over abstinence (e.g. rape, sexual abuse)
 Be Faithful
o Fidelity (faithful to one person), sexual relationship with one person
o Eliminate casual sexual partnerships
o Adoption of social and community norms that denounce cross generational sex, rape, or
forced sexual activity
 Correct and Consistent use of Condoms
o Accurate information, proper demonstrations
o Condoms provide 80-90% protection
o Latex condoms can also reduce other STI (gonorrhea, chlamydia, genital uterine diseases
Step 4: Approaches in HIV and AIDS Prevention
PMTCT (Prevention of Mother to Child Transmission)

 Mother-to-child transmission (MTCT) of HIV refers to the transmission of HIV infections from HIV-
infected mothers to their infants.
o MTCT can occur during pregnancy, labour and delivery, and breast-feeding.
o Without intervention, the overall risk of MTCT is approximately 20% to 45%..
 There are multiple risk factors that increase the chance of a mother in transmitting HIV to her child:
o High maternal viral load and low CD4 cell count
o Virulence of viral subtypes and strains

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o Obstetric and neonatal risk factors:
 High maternal viral load and low CD4 cell count
 Viral, bacterial or parasitic placental infections
 Sexually transmitted Infections (STIs)
 Oral disease in the infant
 Breast abscesses,
 Mixed feeding
 Duration of breast-feeding
HIV counseling and testing

 Know your status
o If negative, can help you stay negative
o If positive can provide proper treatment
o If positive helps stop you from transmitting to someone else
Provider Initiative Counseling and Testing
 PICT is voluntary and requires consent from the client.

 It is performed in the clients best interests, in keeping with acceptable principles of medical
ethics,
 HIV results are always reported back to the client.
 The client is supported to deal with the HIV test results.
 Counselling always precedes and follows testing.
 In implementing PICT medical practitioners should be guided by three principles, also known
as the three Cs.
o Consent,
o Counselling
o Confidentiality,
Male Circumcision
 Current research from Tanzania and other African countries indicates male circumcision can be
a preventative measure against HIV
 Tanzania is in the process of establishing a policy
 How does it help in prevention?
o It removes tissue in the foreskin that is vulnerable to the virus
Step 5 Key Points (5minutes)

HIV and AIDS prevention measures are:-
 HIV counseling and testing
 Treatment and prevention of STI
 Prevention of Mother to Child Transmission (PMTCT)
 ABC approach
 Circumcision
 Safe Blood supply
 Post Exposure Prophylaxis (PEP)
 Media

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 In implementing PICT medical practitioners should be guided by three principles, also known
as the three Cs.
o consent,
o counseling
o confidentiality
Step 6:Session Evaluation (5minutes)
 What is PIT in relation to HIV & AIDS?

 What are the ABC HIV & AIDS Prevention approach?
 How does male circumscion prevent HIV infection?
References
National Guidelines for the Clinical Management of HIV/AIDS. MOH, Tanzania.December 2017
Laeyendecker, O., Li. X., Arroyo, M. et al, "The Effect of HIV Subtype on Rapid Disease
Progression in Rakai, Uganda"13th Conference on Retroviruses and OpportunisticInfections (abstract

no. 44LB), February 2006
World Health Organization/UNAIDS. Guidance on provider-initiated HIVtesting and counselling in health
facilities. May 2007. http://whqlibdoc.who.int/publications/2007/9789241595568_eng.pdf (accessed 15
April 2010).
World Health Organization/UNAIDS. Guidance on Provider-initiated HIV Testing andCounseling in
Health Facilities, May 2007. Geneva: WHO, 2007.
SESSION 03 CARE OF A PATIENT WITH TYPHOID FEVER

Prerequisite: None
Learning tasks
Define typhoid fever
Identify causative agents of typhoid fever
Explain mode of transmission of typhoid
Outline signs and symptoms of a patient with typhoid fever
Identify
NMT 05211: diagnostic
Management measuresDiseases
of Communicable of typhoid fever
Explain complications of typhoid fever. 224
Outline prevention and control of typhoid fever.
224
Give nursing care to patient with typhoid fever
Session Overview

2. 05 Brainstorming Presentation Definition of Typhoid fever and Causative agents of
Typhoid fever
3 05 Presentation Mode of transmission of Typhoid fever
.4 10 Lecture/Discussion Signs and symptoms of patients with Typhoid fever
.5 05 Presentation Diagnostic measures of Typhoid fever
6 05 Presentation Complications of Typhoid fever
7 10 Lecture/Discussion Treatment and nursing care of a patient with Typhoid
Fever
8 05 Lecture/Discussion Preventive and control measures of Typhoid Fever
Session Contents
STEP 2: Definition of Typhoid Fever (5min)

ASK students to buzz on definitions of Typhoid Fever and identify causative agent
Definition
Definition
 Typhoid fever is a systemic infectious disease characterized by high continuous fever,
malaise and involvement of lymphatic tissues and spleen.

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Causative organisms
 Salmonellae Thyphi causes typhoid in humans
Step 3: Mode of transmission of Typhoid fever (5minutes)

Activity: Brainstorm (2 minutes)
ASK students to list mode of transmission of Typhoid fever
ALLOW few students to respond and let others provide unmentioned response
CLARIFY and summarize using the information below
 The Salmonellae are passed out in faeces and urine of cases or carriers
 The main ways of transmission are through contaminated water and food
Step 4: Signs and Symptoms of Patients with Typhoid Fever (10minutes)

 Incubation period is 2-3 weeks
 The onset is gradual as follows:
First week
 Severe headache
 Malaise
 Anorexia
 Body pains
 Epistaxis
 Rise of temperature in steps
 Constipation
 Slow pulse rate
 Enlargement of the spleen and tender
Second week
 Continuous high temperature
 Mental confusion and hallucination
 Disorientation
 Distended abdomen
 Diarrhoea (pea soup diarrhea)
Step 5:Diagnostic Measures of Typhoid fever(5minutes)

 Diagnosis is made by
 blood
 bone marrow
 stool
o for cultures and with the Widal test
o The Widal test is one method that may be used to help make a presumptive diagnosis of
typhoid fever. also known as enteric fever,
Step 6:Complications of Typhoid (5minutes)

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The 2 most common complications in untreated typhoid fever are:
 Internal bleeding in the digestive system
Most internal bleeding that occurs in typhoid fever isn't life threatening, but it can make you feel
very unwell.
 Perforation
Perforation is potentially a very serious complication. This is because bacteria that live in your
digestive system can move into your stomach and infect the lining of your abdomen (the
peritoneum). This is known as peritonitis.
Step 7: Treatment and nursing care of a patient with Typhoid Fever (10minutes)
 Give one of the following antibiotics
o Ciprofloxin 500 mg orally twice for 10-14 days Or
o Ceftriaxone 1g 3 times daily for 14 days
 If the patient is very sick and admitted give care as for other sick patients
 Adhere to standard precautions in Infection Prevention and Control (IPC) when caring the
 Make sure the patient has a rest,
 Advice the patient to drink plenty of fluids and eat regular meals.
Step 08: Preventive and control measures of Typhoid Fever(5minutes)

 Early diagnosis of cases or carriers and proper treatment
 Proper disposal of human excreta and refuse
 Washing of fruits before eating
 Encourage people to construct and use latrine
 Health education of how the disease is spread and its prevention etc.
 Vaccination against typhoid fever is recommended if you're travelling to parts of the world where
the condition is common.
 Typhoid is found throughout the world, but it's more likely to occur in areas where there's poor
sanitation and hygiene.
Step 9: Key Points(5minutes)
 Typhoid fever is a systemic infectious disease characterized by high continuous fever, malaise
and involvement of lymphatic tissues and spleen while paratyphoid presents as gastro enteritis
or transient diarrhea
 The route of transmission is faecal oral through contaminated food and water
 Prevention is mainly through sanitation and food hygiene
Step 10: Evaluation (5minutes)
 What are the signs and symptoms of Typhoid fever?

 What are the complications of Typhoid fever?

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SESSION 03 CARE OF A PATIENT WITH TINEA INFECTION
Prerequisite: None
Learning tasks
Define Tinea
Identify types of Tinea infections
Explain epidemiological distribution of common Tinea infection
Describe clinical picture of the patient with Tinea infection
Explain treatment required for a patient with Tinea infection
Explain preventive and control measures of Tinea infection
Provide nursing care to patient with Tinea infection
Session Overview
Step Time Activity/ Method Content
(min)
2. 05 Brainstorming Presentation Definition of Tinea
3. 05 Lecture and Discussion Epidemiological distribution of common tinea infection

4. 10 Lecture and Discussion Clinical picture of the patient with tinea infection
5. 15 Presentation Treatment and Nursing care for a patient with tinea
infection
6. 10 Lecture and Discussion Preventive and control measures of tinea infection
Session Contents
Step 1: Presentation of Session Title and Learning Tasks (5minutes)
Step 2: Definition of Tinea (5minutes)

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ASK students to buzz on definitions of Tinea
ALLOW 2 to 3 students to provide responses and let others provide additional responses 228
 Tinea or dermatomycosis is the term used to denote fungal infection of the skin andmucous
membrane.
Step 3: Epidemiological Distribution of Common Tinea infection (05 minutes)
 Up to 20% of the population may be infected by ringworm at any given time.

 Infections of the groin are more common in males, while infections of the scalp and body occur
equally in both sexes
 Infections of the scalp are most common in children while infections of the groin are most common
in the elderly
Step 4: Clinical Picture of the Patient with Tinea infection (10minutes)

 The clinical picture of Tinea depends on the type of ringworms
 The following are the clinical manifestations of Tinea according to the type:
Dermatomycosis or ringworm
 Is spread by direct or indirect contacts
o Direct contact - skin to skin of an infected person
o Indirect contact - contact with contaminated clothes or beddings
During sexual intercourse as in balanitis and vulvo-vaginitis
Tinea carpitis
 It occurs mainly in children under 10 years
 Small lesion which starts on the scalp and spread to involve a large area
 Hair is affected and breaks off easily
Tinea corporis
 fungal infection of the arms, legs, and trunk characterized by:
o Flat, ring-shaped spreading lesions which are reddish,vasicular or pastular
o Lesions may be dry scaly, or moist and crusted
Tinea pedisis (athlete's foot)

 Fungal infection of the feetcharacterized byscaling and cracking of the skin between the toes
Tinea unguim
 Fungal infection of thenails characterized by:
o Thickening, discoloration of one or more nails
o Accumulation of caseous materials beneath the nail which becomes chalky anddisintegrates

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Tinea versicolor or pityriasis
 Is a very superficial infection of the skin on the side of the face, neck and chest shows many
irregular,round,lightcoloredareas
Step 5: Treatment and Nursing Care of the Patient with Tinea (15 minutes)
The treatment depends on the type and site of infection
Tinea capitis
 Griseofulvin is the drug of choice, although oral therapy with itraconazole and terbinafineare
effective alternatives
 Oral fluconazole has similar efficacy to Griseofulvin
 Griseofulvin
o Adults: 250 mg twice daily orally for 6 to 12 weeks
o Children: 20-25mg/kg of body weight for 6 to 12 weeks
 White fields ointment applied to the affected area twice daily for 3 to 6 weeks, can be used when
the above drugs are not available
Tinea corporis
 Topical application of antifungal drug
 Clotrimazole 1% cream, lotion or solution twice daily
 Topical application of ketoconazole cream once daily
Tinea pedis
 Topical application of ketoconazole and Griseofulvin for four weeks are usually effective
 Chronic or extensive disease may require systemic therapy with
o Griseofulvin 250mg to 500mg twice daily
o Eerbinafine 250mg daily
o Itraconazole 200mg daily
Tinea unguim
 Systemic antifungals are given
 Terbinafine and 250mg daily for 6 weeks in fingernail infections, and for 12 weeks in toenail
infections
 Intraconazole 200mg daily for 6 weeks in finger nails infections, and for 12 weeks in toenail
infections
Step 6: Prevention and Control Measures of Tinea (10 Minutes)
The following are the preventive and control measures of tinea:

 Improvement of personal hygiene
 Early diagnosis and proper treatment of individual patient
 Health education to the community about the importance of good personal hygiene
 Conduct mass treatment to infected school children

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 Refer skin diseases of uncertain diagnosis
Step 7: Key Points (5 minutes)

Tinea or dermatomycosis is the term used to denote fungal infection of the skin andmucous membrane.
Tinea capitis is treated by
 Griseofulvin is the drug of choice, although oral therapy with itraconazole and terbinafineare
effective alternatives
 Oral fluconazole has similar efficacy to Griseofulvin
 Griseofulvin
o Adults: 250 mg twice daily orally for 6 to 12 weeks
o Children: 20-25mg/kg of body weight for 6 to 12 weeks
 White fields ointment applied to the affected area twice daily for 3 to 6 weeks, can be used when
the above drugs are not available
 What are the clinical features of a patient with Tinea?

 What are the prevention of tinea?
References
Allender J, Spradley B. (2001) Community Health Nursing Concepts and Practice.(5th
ed.).Philadelphia. New York. Baltimore: Lippincott
Basavanthappa B, (2006) Community health nursing (2nd ed.).New Delhi: Jaypee brothers
Nordberg, E. et al, (2007), Communicable diseases A manual for health workers in sub-Saharan Africa
Nairobi. AMREF 4th edition
Stanhope M, Lancaster J. (2000) Community public health nursing.( 5th ed. ). St.Philadelphia. Mosby
Stone S, MacGuire S, Eigist D. (2002) Comprehensive community health nursing- Family,
Aggregate& community practice. (6th ed.).St. Louis London Philadelphia SydneyToronto. Mosby
Wood, C. et al (2008), Community health (3rd ed.). Nairobi. AMREF
SESSION 01 THE CONCEPTS OF FAECAL-ORAL DISEASES

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Prerequisite: None
Learning tasks
Define faecal oral diseases
Enumerate faecal oral diseases
Explain the transmission cycle of faecal oral diseases
Explain preventive and control measures of faecal oral diseases
Session Overview

2. 05 Brainstorming Definition of faecal oral diseases
Presentation
3. 10 Lecture/Discussion Faecal oral diseases
4. 15 Lecture/Discussion Transmission cycle of faecal oral diseases
5. 15 Presentation preventive and control measures of faecal oral diseases
Session contents
STEP 2: Definition of faecal oral diseases (5min)

ASK students to buzz on definitions of faecal oral diseases

Definition
WRITE their responses
 Faecal in the
oral diseases chalk/white
describes board or flip
a particular chartof transmission of a disease where
route
pathogens in fecal particles pass from one person to the mouth of another person.
o Faecal oral transmission of organisms occurs through contamination of hands, water and food
o Flies also carry faecal materials
Step 3: Common Faecal oral diseases (5minutes)

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o Cholera
o Typhoid fever
o Dysentery
o Amoebiasis
o Acute gastro- enteritis
Step 4: Transmission cycle of faecal oral diseases

 Contaminated food, water and hands
 Hands may become contaminated after defecation or by touching contaminated objects
 The house fly carry faecal material to human food.
The "F-diagram" (feces, fingers, flies, fields, fluids, food), showing pathways of fecaloral disease
transmission. The vertical blue lines show barriers: toilets, safe water, hygiene and handwashing.
Step 5: Preventive and Control measures of faecal oral diseases (15minutes)

 Prevention of faecal oral diseases depends on breaking the faecal oral transmission cycle
 The following are general prevention and control measures of faecal oral diseases
o Improve methods of stool disposal Use of properly constructed latrines
o Hand washing facilities should be provided outside toilets
o Fly control by proper refuse disposal, faeces disposal and covering latrines
o Proper cooking and handling of food
o Protection of water sources
o Boiling of drinking water
o Wash hands after attending to toilet, before food preparation and before eating

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o Food handlers should be routinely screened and treated if necessary
o Proper washing of fruits before eating
Step 6: Key points (5minutes)

 Faecal oral transmission of organisms occurs through contamination of hands, water and food
 Flies also carry faecal materials
o Cholera
o Typhoid fever
o Dysentery
o Amoebiasis
o Acute gastro- enteritisa

 What does faecal oral diseases means?
 How will you Prevent and Control faecal oral diseases?
References:
Washington DC: WHO
Philadelphia: Mosby
Sydney Toronto: Mosby

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SESSION 02 CARE OF A PATIENT WITH CHOLERA

Prerequisite: None
Learning tasks
Define cholera
Outline causative agents of cholera
Explain mode of transmission
Outline signs and symptoms of patients with cholera
Explain diagnostic measures of cholera
Identify stages of cholera
Explain complications of cholera
Outline preventive and control measures of cholera
Manage patient with Cholera
Session Overview
1. 05 Presentation Introduction, Learning Tasks

2. 05 Brainstorming Presentation Definition of cholera and Causative agents of cholera
3. 10 Lecture/Discussion Signs and symptoms of patients with cholera
4. 05 Presentation Diagnostic measures of cholera
5. 05 Presentation Stages of cholera
6 05 Presentation Complications of cholera
7 10 Lecture/Discussion Treatment and nursing care of a patient with cholera
8 05 Lecture/Discussion Preventive and control measures of cholera
Session contents

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STEP 2: Definition of Cholera (5min)

ASK students to buzz on definitions of Cholera and identify causative agent

Definition
Definition:
 Cholera is an acute intestinal disease transmitted through faecal oral route, characterized
by sudden onset of profuse rice watery stool, vomiting; rapid dehydration and circulatory collapse.
Causative organism
 Gram negative organism known as Vibrio cholerae (EL Tor vibrio)
Step 3: Signs and symptoms of patients with cholera (10 minutes)

 Most cholera infections are asymptomatic or cause only simple self limiting diarrhea
 The signs and symptoms occur 2- 3 days after invasion of microorganism
 Fever is low or absent
 The disease develop in three stages
Stage one
 Profuse watery stool
 Soon faecal matter disappears followed by clear fluid with mucous and rice water appearance
stool
 Vomiting at first food but later rice water vomitus
 Severe cramps in the abdomen develops due to loss of salt
Stage two
 Collapse due to dehydration
 The body becomes cold, dry skin and inelastic
 Blood pressure is low or unrecordable
 Anuria and shock
Stage three
 Diarrhoea decreases
 General condition improves
Step 4: Complications of cholera (05 minutes)

Dehydration and electrolytes imbalance
Malnutrition
Shock

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Step 5: Treatment and nursing care of a patient with cholera (10minutes)
Do not refer a suspected cholera case but inform the District authority.
 Isolate the patient in a temporary unit
 Give intravenous fluid (Ringers lactate) in order to restore hydration (treat dehydration
according to classification of dehydration (Care of Diarrhoeal Diseases)
 If possible take rectal swab for laboratory investigation
 Give drugs:
o Doxycycline 300mg as a single dose
o Erythromycin500mg tds for 7 days
 Treat patient in cholera bed with the central hole through which continuous stool can pass into
the bucket containing disinfectant
 Send information to the district authority
 Keep accurate record of all cases, their progress and report to the district authority every day
 Nurse the patients as other sick patients
 Adhere to standard precautions in infection prevention and control when caring cholera patients
Rehydration will save almost all cholera cases.
Refer students to Handout 02:01 and 02:12 Dehydration and Rehydration, Cholera bed
Step 6: Preventive and control measures of cholera (05 minutes)
 Find out the source of the diseases and transmission

 Early diagnosis and proper treatment
 Admit cholera cases in a special unit
 Give prophylaxis (doxycycline 300mg) to all members or contacts of the patients
 Conduct continuous monitoring of all aspects of the disease including collecting of the disease
morbidity and mortality rates
 Burial of cholera cases should be supervised by medical personnel
 Report to the District Medical Officer (DMO) if there is an outbreak of cholera
 Working with the village government in tracing cholera cases and assisting in educating the
community
 Health education to the community on:
o Proper use of latrine by all household members in a clean manner
o Importance of boiling drinking water
o Importance of hand washing after attending toilet, before food preparation and before eating
o Protecting food and eating utensils from flies
o Food hygiene and eating food while hot
o Cleaning the surroundings to destroy flies breeding places
o Mode of spread of cholera and its prevention
Step 07: Key Points:( 5 minutes)

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 Cholera is one of the gastrointestinal disease caused by vibrio cholera and it is transmitted by
faecal oral route
 The typical sign of cholera is diarrhea and vomiting (rice water appearance fluid) leading to
shock
 When there is an outbreak of cholera do not refer suspected cases of cholera but notify to
DMO
 Early diagnosis and rehydration therapy will save almost all cholera cases
 Cholera is a national notifiable disease
Step 08: Evaluation (5 minutes)
What is the management of cholera?

How can you prevent cholera?
References

Washington DC: WHO
Philadelphia: Mosby
Handout 02.01: Dehydration and Rehydration
DEHYDRATION AND REHYDRATION
Signs and Symptoms of Dehydration
 Moderate Dehydration
 Restlessness and irritability
 Sunken eyes

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 Dry mouth and tongue
 Increased thirst
 Skin goes back slowly when pinched
 Decreased urine
 Decreased tears, depressed fontanels in infants
 Severe Dehydration
 Lethargy or unconsciousness
 Very dry mouth and tongue
 Skin goes back very slowly when pinched (tenting)
 Weak or absent pulse
 Low blood pressure
 Minimal or no urine
Rehydration
 Rehydration is the cornerstone of treatment for cholera.

 Oral rehydration salts and, when necessary, intravenous fluids and electrolytes, if administered
in a timely manner and in adequate volumes, will reduce fatalities to well under 1% of all
patients.
 Patients with severe acute malnutrition should receive oral rehydration with low-osmolarity
ORS solution instead of the standard rehydration solution for diarrhea, ReSoMal. ReSoMal
does not have sufficient sodium content to replace the losses from cholera
 Breastfed infants should continue to breastfeed.
 Other types of fluids, such as juice, soft drinks, and sports drinks should be avoided.
A man being treated for choler
Handout 02.02: Cholera

Bed

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SESSION 03 CARE OF A PATIENT WITH TYPHOID FEVER

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Prerequisite: None
Learning tasks
Define typhoid fever
Identify causative agents of typhoid fever
Explain mode of transmission of typhoid
Outline signs and symptoms of a patient with typhoid fever
Identify diagnostic measures of typhoid fever
Explain complications of typhoid fever.
Outline prevention and control of typhoid fever.
Give nursing care to patient with typhoid fever
Session Overview
1. 05 Presentation Introduction, Learning Tasks

2. 05 Brainstorming Presentation Definition of Typhoid fever and Causative agents of
Typhoid fever
3 05 Presentation Mode of transmission of Typhoid fever
.4 10 Lecture/Discussion Signs and symptoms of patients with Typhoid fever
.5 05 Presentation Diagnostic measures of Typhoid fever
6 05 Presentation Complications of Typhoid fever
7 10 Lecture/Discussion Treatment and nursing care of a patient with Typhoid
Fever
8 05 Lecture/Discussion Preventive and control measures of Typhoid Fever
Session contents
STEP 2: Definition of Typhoid Fever (5min)

ASK students to buzz on definitions of Typhoid Fever and identify causative agent
ALLOW
NMT 05211: students to provide
Management responses
of Communicable and let others provide additional responses
Diseases
241
CLARIFY and summarize their responses using the content below 241
Definition
Definition
 Typhoid fever is a systemic infectious disease characterized by high continuous fever,
malaise and involvement of lymphatic tissues and spleen.
Causative organisms
 Salmonellae Thyphi causes typhoid in humans
Step 3: Mode of transmission of Typhoid fever (5minutes)

Activity: Brainstorm (2 minutes)
ASK students to list mode of transmission of Typhoid fever
ALLOW few students to respond and let others provide unmentioned response
CLARIFY and summarize using the information below
 The Salmonellae are passed out in faeces and urine of cases or carriers
 The main ways of transmission are through contaminated water and food
Step 4: Signs and symptoms of patients with Typhoid fever (10minutes)

 Incubation period is 2-3 weeks
 The onset is gradual as follows:
First week
 Severe headache
 Malaise
 Anorexia
 Body pains
 Epistaxis
 Rise of temperature in steps
 Constipation
 Slow pulse rate
 Enlargement of the spleen and tender
Second week
 Continuous high temperature
 Mental confusion and hallucination
 Disorientation
 Distended abdomen
 Diarrhoea (pea soup diarrhea)
Step 5:Diagnostic Measures of Typhoid fever(5minutes)

 Diagnosis is made by

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 blood
 bone marrow
 stool
o for cultures and with the Widal test
o The Widal test is one method that may be used to help make a presumptive diagnosis of
typhoid fever. also known as enteric fever,
Step 6:Complications of Typhoid (5minutes)
The 2 most common complications in untreated typhoid fever are:
 Internal bleeding in the digestive system
Most internal bleeding that occurs in typhoid fever isn't life threatening, but it can make you feel
very unwell.
 Perforation
Perforation is potentially a very serious complication. This is because bacteria that live in your
digestive system can move into your stomach and infect the lining of your abdomen (the
peritoneum). This is known as peritonitis.
Step 7: Treatment and nursing care of a patient with Typhoid Fever (10minutes)
 Give one of the following antibiotics
o Ciprofloxin 500 mg orally twice for 10-14 days Or
o Ceftriaxone 1g 3 times daily for 14 days
 If the patient is very sick and admitted give care as for other sick patients
 Adhere to standard precautions in Infection Prevention and Control (IPC) when caring the
 Make sure the patient has a rest,
 Advice the patient to drink plenty of fluids and eat regular meals.
Step 08: Preventive and control measures of Typhoid Fever(5minutes)

 Early diagnosis of cases or carriers and proper treatment
 Proper disposal of human excreta and refuse
 Encourage people to construct and use latrine
 Health education of how the disease is spread and its prevention etc.
 Vaccination against typhoid fever is recommended if you're travelling to parts of the world where
the condition is common.
 Typhoid is found throughout the world, but it's more likely to occur in areas where there's poor
sanitation and hygiene.
Step 9: Key Points(5minutes)

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 Typhoid fever is a systemic infectious disease characterized by high continuous fever, malaise
and involvement of lymphatic tissues and spleen while paratyphoid presents as gastro enteritis
or transient diarrhea
 The route of transmission is faecal oral through contaminated food and water
 Prevention is mainly through sanitation and food hygiene
 What are the signs and symptoms of Typhoid fever?

 What are the complications of Typhoid fever?
References

Washington DC: WHO
Philadelphia: Mosby
SESSION 04 CARE OF A PATIENT WITH CONJUCTIVITIS

Prerequisite: None
Learning tasks
Define conjunctivitis
Explain epidemiological distribution of conjunctivitis
Outline clinical features of conjunctivitis
Identify diagnostic measures of conjunctivitis
Explain treatment of a patient with conjunctivitis
Describe methods of prevention and control of conjunctivitis
Manage patient with conjunctivitis
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Session Overview

2. 05 Brainstorming Definition of conjunctivitis
Presentation
3. 05 Lecture and Discussion Epidemiological distribution of conjunctivitis
4. 10 Lecture and Discussion Clinical features of conjunctivitis
5. 15 Presentation Transmission route and Diagnostic measures of
conjunctivitis
6. 10 Lecture and Discussion Treatment and Nursing care of the patient with
conjunctivitis
Prevention and control of conjunctivitis

Session Contents
Step 1: Presentation of Session Title and Learning Tasks (5 minutes)
Step 2: Definition of Conjuctivitis (5min)

ASK students to buzz on definitions of Conjuctivitis

 Conjunctivitis is an inflammation of mucous membrane lining the inner surface of the eyelids
and the cornea
Section 3: Epidemiological Distribution of Conjunctivitis (5 Minutes)

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 Acute conjunctivitis is a clinical condition characterized by watery discharge, rediness and
swelling of the conjunctiva and edema of the eyelids
 It is common and widespread throughout Tanzania particularly in dry and hot areas and is
highly contagious.
 Transmission is favored by low socioeconomic status and shortage of water supply and
dusty environment
Step 4: Clinical Features of Conjunctivitis (10 minutes)

 Clinical features of viral conjunctivitis:
o Excessive watering
o Itching
o Pinkness of the conjunctiva
o Redness
o Swelling of the conjunctiva
o Increased production of tears
 Clinical features of bacterialconjunctivitis(Staphylococcus, Streptococcusand Hemophilus):
o Conjunctival redness
o Swelling of the eyelid
o Sticky discharge
o Symptoms develop first in one eye, but may spread to the other eye within 25 days.
Step 5: Mode of Transmission and Diagnostic Measures of Conjunctivitis

(10Minutes)
Mode of Transmissionof Conjunctivitis:

 By contact with ocular discharges or secretion from therespiratory tract of an infected person
through contaminated fingers, clothes, and otherarticles
 Flies may also transmit the disease
Diagnostic measuresof Conjunctivitis:
 Microscopic examination of
o Stained smear
 Culture of the discharge is required to differentiate bacterial from viral or allergic conjunctivitis,
or adenovirus/enterovirus infection. Physical examination
Step 6: Treatment and Nursing Care of the Patient with Conjunctivitis (15 minutes)
ACTIVITY: Brainstorming (5 minutes)
ASK students to brainstorm on Treatment and Nursing careof a patient with conjunctivitis
ALLOW few students to respond and let others provide unmentioned responses
WRITE their responses on flip chart/board

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CLARIFY and summarize by using the information bellow
Treatment and Nursing Care

 Cleaning the eyes regularly with water
 Apply chloramphenical eye ointment or tetracycline 1% for at least 5 days
 Instruct relatives how to apply the ointment or drops at home
 Apply antibiotic eye ointment to patient with purulent conjunctivitis
Step 7: Prevention and Control of Conjunctivitis (10Minutes)

The following are the prevention and control measures of conjunctivitis:
 Good personal hygiene practice
 Washing of the face and eyes regularly to avoid attraction of flies
 Proper care and treatment of affected eyes
 Proper refuse disposal to prevent fly breeding
 Provision of adequate clean water
 Provide health education in
o Schools
o Health facility
o Community
o Emphasizing on the importance of personal hygiene and proper refuse disposal
Step 8: Key Points (5Minutes)

 Conjunctivitis is transmitted through direct contact with ocular secretion or
throughcontaminated hands or articles and flies.
 Transmission is favored by low socioeconomic status and shortage of water supply anddusty
environment
Step 9: Session Evaluation (10 minutes)

 What are the means of preventing and controlling acute conjunctivitis in different groupsof
people?
 How will you treat a person with acute conjunctivitis?
References
Allender J, Spradley B. (2001) Community Health Nursing: Concepts and practice. (5th
ed.).Philadelphia. New York. Baltimore. Lippincott
Stone S, MacGuire S, Eigist D. (2002) Comprehensive community health nursing: Family,
Aggregate& community practce (6th ed.).St. Louis London Philadelphia Sydney Toronto.Mosby

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247
Wood C. (2008). Community health. (3rd ed.). Nairobi. AMREF
Nordberg E. et al, (2007) Communicable diseases: A manual for health workers in sub-Saharan Africa.
Nairobi: AMREF
Basavanthappa B, (2006). Community health nursing (2nd ed.). New Delhi: Jaypee brothers.
SESSION 05 CARE OF A PATIENT WITH TRACHOMA

Prerequisite: None
Learning tasks
Define trachoma
Identify causative agent of trachoma
Explain epidemiological distribution of trachoma
Outline clinical picture of a patient with trachoma
Identify diagnostic measures of trachoma
Explain treatments of patient with trachoma
Describe ways to prevent and control trachoma
Manage a patient with trachoma
Session Overview
1. 05 Presentation Introduction, LearningTasks

2. 05 Brainstorming Definition of trachoma
Presentation
3. 05 Lecture/Discussion Causative agent and risk factors of trachoma
4. 10 Lecture/Discussion Epidemiological distribution of trachoma
5. 15 Presentation Clinical picture of a patient with trachoma
6. 10 Lecture/Discussion Diagnostic measures of trachoma
Treatments and Nursing care of patient with trachoma
Prevention and control of trachoma

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Session contents
Step 1: Presentation of Session Title and Learning Tasks (5 minutes)
Step 2: Definition of Trachoma (5min)

ASK students to buzz on definitions of Trachoma

Definition
 Trachoma is a chronic inflammation of the conjunctiva and cornea characterized by follicular
conjunctivitis followed by vascular invasion of the cornea (Pannus)
 In the later stages scarring of the conjunctiva causes inturnig of the eyelashes and lid
deformities, causing chronic abrasion of the cornea and scaring leading to blindness
Step 3: Causative agents and Risk factors of trachoma (5minutes)

Trachoma is caused by Chlamydia trachomatis
Risk Factors for Developing Trachoma

 Dry and dusty areas
 Poor hygiene with presence of flies
 Overcrowding
 Areas with shortage of water supply
Step 4: Epidemiological distribution of trachoma (10 minutes)

 The disease occur worldwide, as an endemic disease most often of poor rural communities in
developing countries.
 In endemic areas,trachoma presents in childhood, then subsides in adolescence, leaving
varying degrees of potentially disabling scarring.
 Blinding trachoma is still widespread in the Middle East, northern and sub-Saharan Africa, parts
of the Indian subcontinent, southeastern Asia and China. Pockets of blinding trachoma also
occur in Latin America, Australia (among Aboriginals) and the Pacific islands.
 The disease occurs among population groups with poor hygiene, poverty and crowded living
conditions, particularly in dry dusty regions.
Step 5: Clinical Picture of a Patient with Trachoma (10 minutes)

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Transmission occurs through contact with ocular discharge of infected person
 It can be either directly via fingers contaminated with discharge or indirectly through formites
and flies. Trachoma develops in four stages
Stage I: Trachomatous inflammation-Follicular-TF

This stage is characterized by:
 Red, watery eyes like ordinary conjunctivitis with mild irritation and itching
 After a month or more, small pinkish- grey lumps called follicles form inside the white of the eye
and is mildly inflamed with little pus formation
Figure 5:1 : Stage II: Trachomatous inflammation-Follicular-TF
Source: Nordberg, E, Kingondu, T. (2007).Communicable diseases 4th ed.). Nairobi. AMRF
Stage II: Trachomatous Inflammation Intense (TI)

 Intense diffuse inflammatory infiltration
 Oedema and vascular papillary hypertrophy
 The top edge of the cornea looks grayish
Figure 5:2 : Stage II: Trachomatous Inflammation Intense
Stage III Trachoma Scarring TS

 After several years the follicles begins to disappear leaving whitish scars on the conjunctiva
 Some vision may remain unless gross damage, like rupture of cornea has occurred

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Figure 5.3:Stage III Trachoma Scarring TS
Stage IV (Trachoma Trichiasis TT)

 Scar tissue formed retracts and makes the eyelid thick and turned inwards (entropion)
 The scar makes the eyelids thick and narrow and may pull the eyelashes down into the eye,
scratching the cornea whenever the patient blinks (trichiasis)
 The combination of entropion and trichiasis will completely destroy the cornea resulting in
blindness.
Figure 5:4 : Stage I(Trachoma Trichiasis TT
Figure 5:5 : Scars
Step 6: Treatments and Nursing care of patient with trachoma (10 minutes)

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 Tetracycline,Azithromycin,Erythormycin and sulphonamides
 Tetracycline 3% topical eye ointment
 Sulphonamides are potentially dangerous drug and can only be given under guidance and
supervision
 Azithromycin 20mg.kg of body weight orally as single dose
 Patients in stage IV of the disease with entropion must be treated surgically
 Refer the patient for surgical treatment to patients who are at stage IV
Step 7: Prevention and control of Trachoma (15minutes)
ACTIVITY: Brainstorm (5 minutes)
ASK students to brainstorm on Prevention and Control of Trachoma
ALLOW few students to respond and let others provide unmentioned responses
WRITE their responses on flip chart/board
CLARIFY and summarize by using the information bellow
Trachoma is caused by lack of water

 The most effective way of dealing with the trachoma problem is to have enough water near
peoples home
 Supply of clean water near every house
 Washing faces of children with soap and water regularly
 Regular bathing
 Proper disposal of refuse and excreta:
 Construction and proper use of latrine
 Proper disposal of house hold refuse
 Destroy flies breeding places
 Educate all infected people to seek treatment
 Early diagnosis and active treatment of all infected cases
Step 8: Key points (5 minutes)

 Trachoma is a chronic inflammation of the conjunctiva and cornea characterized by follicular
conjunctivitis
 The most effective way of dealing with the trachoma problem is to have enough water near
peoples home
What are the Risk Factors for Developing Trachoma?

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What are the signs and symptoms of Trachoma?
References
Nordberg E. et al, (2007) Communicable diseases: A manual for health workers in sub- Saharan Africa.
Nairobi: AMREF
Basavanthappa B, (2006). Community health nursing (2nd ed.). New Delhi: Jaypee brothers.
Ngatia, P, Tiberry,P, Oirere,B, Rabar,B, Waithaka.M. (2008). Community health (3rd ed.). Nairobi:
AMREF
Heymann D.(2008). Control of communicable diseases manual (19th ed.). Washington DC: WHO
Stanhope, M, Lancaster J.(2000). Community public health nursing (5th ed.)St.Louis London.
Philadelphia Sydney Toronto
Nordberg, E, Kingondu, T. (2007).Communicable diseases 4th ed.). Nairobi. AMRF
SESSION 5: CARE OF A PATIENT WITH DYSENTERY

Prerequisite: None
Learning Tasks
Define dysentery
Identify causative agents of dysentery
Explain mode of transmission of dysentery
Outline signs and symptoms of patients with dysentery
Identify diagnostic measures of dysentery
Outline complications of dysentery
Outline prevention and control measures of dysentery
Manage patient with dysentery
Session Overview

2. 05 Brainstorming Presentation Definition of Dysentery

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3. 05 Lecture Discussion Causative agents and mode of transmission of
Dysentery
4. 10 Presentation Signs and Symptoms of patients with Dysentery
5. 10 Presentation Diagnostic measures andComplications of dysentery
7. 05 Lecture Discussion Prevention and control measures of dysentery
8 10 Lecture Discussion Treatment and Nursing care of a patient with
Dysentery
Session Contents
STEP 2: Definition Dysentery (5 Minutes)
ASK students to buzz on definitions of Dysentery
Definition
 Dysentery is an acute diarrhea disease characterized by bloody stool, fever, vomitingand

abdominal cramps
 Dysentery is an infectious disease characterized by inflammation of the intestine, abdominal pain,
and diarrhea with stools that often contain blood and mucus
Step 3: Causative Agents and Mode of Transmission of Dysentery (5Minutes)

Causative organism
 Bacillary dysentery, or shigellosis, is caused by bacilli of the genus Shigella
Mode of transmission
 Dysentery is transmitted by faecal oral route through direct contamination of food and water or
indirect by contaminated dishes whichare not properly washed
 Food may also be contaminated by flies or unwashed hands
 Individuals swallow the microorganisms through contaminated water or food

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Step 4: Signs and Symptoms of a Patient with Dysentery(05 Minutes)
Clinical features :
 The incubation period of dysentery ranges from 1- 4 days
o The disease may present with mild diarrhoea
o Sudden onset of fever and rapid pulse
o Abdominal cramps
o Diarrhoea with blood and mucous
o After few motions the diarrhea stops and dysenteric syndrome starts
 Colicky abdominal pain
 Tenesmus painful contractions of the sphincter ani
 Continuous and irritable urge to defecate (as the time no faecal matter is found)
 Small quantities of purulent mucous with blood is produced
 There may be vomiting
Later toxaemia is present with the following signs:
 High fever, rapid pulse, convulsions
 Dehydration
 Muscle cramps
 Oliguria
 Shock
 Rectal prolapse in infants
Step 5: Diagnostic Measures and Complications of Dysentery (5minutes)

Diagnosis
 A stool sample usually will be required for analysis
 The following are the test to diagnose dysentery:
o Culture of the stool
o An antibody blood test to rule out the diagnosis of amoebic dysentery
Complications
 Complications from bacillary dysentery include:
o Delirium
o Convulsions
o Coma
 People with dysentery may experience other problems associated with amoebiasis.
o liver abscess.
o weight loss
o intestinal ulcerations
o bowel perforation and
o death.
 The parasites may rarely spread through the bloodstream, causing infection in the lungs, brain, and
other organs.
Step 6: Prevention and Control measures of Dysentery(10 minutes)

255
255
Activity: Buzz (5 minutes)
TELL students to pair up and List preventive and control measures of Bacillary Dysentery
ALLOW few students to respond and let other pairs to provide unmentioned responses
CLARIFY and summarize by using the information below
The following are the prevention and control of dysentery:

 Prevention depends on stopping the faecal oral transmission
 Find out the source of transmission
 Proper disposal of excreta and refuse
 Health education on how the disease is spread and its prevention
Step 7: Treatment and Nursing Care of a Patient with Dysentery (10minutes)

 The vast majority of infections are self-limited and resolve spontaneously without treatment
 For severe infections, the following can be done:
o Adiminister, Cotrimoxazole or Ampicillin or Ciproflaxin

o Treatment of dehydration by:
 Oral Rehydration Salts (ORS) in mild cases
 IV fluids such as Ringers lactate in severe cases
o Give Spasmolytics such as Belladonna to relieve pain
o For serious cases who are admitted give care as for other seriously ill
o Adhere to principles of IPC when nursing the patient
o Encourage the patient to eat high protein diet in order to repair the worn out tissue
o Maintain good personal hygiene
Step 8: Key Points (5Minutes)

 Dysentery is an acute diarrhea disease characterized by bloody stool, fever, vomitingand
abdominal cramps
 The diseases may be mild or serious leading to death if not treated
 The disease is prevented by proper refuse disposal, early diagnosis and treatment ofCarriers
Step 9: Session Evaluation (5Minutes)

 What are the mode of transmission of bacillary dysentery?
 What are the complications of Dysentery?
References
Allender, J, Spradley, B. (2001). Community health nursing: Concepts and practice fifthedition. New
York Baltimore: Lippincott Philadelphia.
Basavanthappa B, (2006) Community health nursing (2nd ed.),New Delhi: Jaypee brothers

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256
Byrne, M, Bennett,F (1986). Community nursing in develping countries: A manual forthe community
nurse second edition. Great Britain: Oxford University
Heymann D. (2008). Control of communicable diseases manual (19th ed). WashingtonDC: WHO
Ngatia, P, Tiberry,P, Oirere,B, Rabar,B, Waithaka.M. (2008) Community health (3rd ed).Nairobi:
AMREF

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THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND

DIRECTORATE OF HUMAN RESOURCE DEVELOPMENT

FACILITATORS GUIDE FOR ORDINARY DIPLOMA

NMT 05211: MANAGEMENT OF COMMUNICABLE DISEASES

NMT 05211: Management of Communicable Diseases ii

NMT 05211: Management of Communicable Diseases iii

NMT 05211: Management of Communicable Diseases iv

Dr. Otilia F. Gowelle

NMT 05211: Management of Communicable Diseases v

SN FULL NAME INSTITUON/ORGANIZATION

Ndementria Arthur Vermand

NMT 05211: Management of Communicable Diseases

NMT 05211: Management of Communicable Diseases

3.2. Objectives for Training Manual

The module sub-enabling outcome as follows:

4.2. Who is the Module For?

4.3. How is the Module Organized?

NMT 05211: Management of Communicable Diseases

NMT 05211: Management of Communicable Diseases

Total Session Time: 60 minutes

2 15 Buzzing /Presentation Concepts of Communicable Diseases

3 15 Brainstorming/Presentation Routes of Communicable Disease

NMT 05211: Management of Communicable Diseases

STEP 2: Concepts of Communicable Diseases (15 Minutes)

Activity: Buzzing (5 minutes)

NMT 05211: Management of Communicable Diseases

STEP 3: Routes of Transmission of Communicable Diseases (15 Minutes)

Activity: Brainstorming (5 minutes)

 Transmission of infection refers to a process, or mechanisms by which an infectious agent or an

 The common transmission routes are shown in figure 1.1

NMT 05211: Management of Communicable Diseases

NMT 05211: Management of Communicable Diseases

STEP 7: Key Points (05 minutes)

STEP 5: Session Evaluation (5 minutes)

NMT 05211: Management of Communicable Diseases

SESSION XXX: PREVENTING DISEASES THROUGH COMMUNITY

Total Session Time: 60 minutes

NMT 05211: Management of Communicable Diseases

Step Time (min) Activity/ Content

2 15 Presentation/buzzing Definition of Prevention

3 15 Presentation/ Levels of Disease Prevention in the

NMT 05211: Management of Communicable Diseases

STEP 2: Definition of Prevention (15 Minutes)

Activity: Buzzing (5 minutes)

STEP 3: Levels of Disease Prevention in the Community (15 Minutes)

Activity: Brainstorming (5 minutes)

NMT 05211: Management of Communicable Diseases

Activity: Brainstorming (5 minutes)

NMT 05211: Management of Communicable Diseases

STEP 7: Key Points (5 minutes)

STEP 6: Session Evaluation (5 minutes)

NMT 05211: Management of Communicable Diseases

SESSION XXX: FORMULATING INTERVENTIONS USING EPIDEMILOGICAL

Total Session Time: 120 minutes

Step Time (min) Activity/ Content

2 10 Presentation/buzzing Identification Epidemiological Data

FACILITATORS GUIDE FOR ORDINARY DIPLOMA